Therapy of chronic hepatitis C: a critical review

Curr Drug Targets Infect Disord. 2003 Mar;3(1):25-32. doi: 10.2174/1568005033342127.

Abstract

Combination therapy (Interferon plus ribavirin) is the current therapeutic gold standard for naive Hepatitis C Virus (HCV)-positive patients and with the recent advent of pegylated (PEG) IFN the rate of the sustained virological response (HCV-RNA clearance 6 months after the end of treatment) is about 54%-56% with a therapeutical gain mainly among patients with unfavourable HCV genotype (1a, 1b); in this subset of patients, a 42%-46% sustained response rate is achieved compared with 33%-36% found among genotype 1 patients treated with the standard therapy. Patients who respond to IFN monotherapy but relapse during the follow-up should be re-treated with combination therapy given for at least 6 months at the minimum dose of 3 MU thrice weekly plus ribavirin 1000 mg/daily. Recent data suggest that prolonging the time of treatment (12 months) may induce a significantly higher rate of sustained response among patients with genotype 1. The efficacy of the combination of IFN and ribavirin in retreating patients with chronic hepatitis C not responding to IFN monotherapy is controversial as it ranges between 0% and 40%. Recent data show an overall rate of sustained response of 23% when an aggressive approach is adopted but increasing the dosage and the time of treatment induces a significant therapeutic benefit only in patients with genotype 1. In conclusion, a therapeutic progress for chronic hepatitis C has been achieved during the last 10 years (56% vs 20% of sustained response rate obtained with IFN monotherapy) but several unresolved issues are yet to be addressed.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Age Factors
  • Alanine Transaminase / blood
  • Animals
  • Blood Coagulation Disorders, Inherited / complications
  • Depressive Disorder / complications
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Genotype
  • Hepatitis C, Chronic / blood
  • Hepatitis C, Chronic / complications
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Interferon-alpha / adverse effects
  • Interferon-alpha / therapeutic use*
  • Pregnancy
  • Recurrence
  • Renal Insufficiency / complications
  • Ribavirin / therapeutic use*
  • Treatment Outcome

Substances

  • Interferon-alpha
  • Ribavirin
  • Alanine Transaminase