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Treatment of chronic hepatitis C in nonresponders to interferon monotherapy

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Abstract

Sixty percent of patients fail to respond to interferon monotherapy. African-Americans with hepatitis C appear to respond less well to interferon monotherapy. Retreatment with a higher dose of consensus interferon for 48 weeks has led to a sustained virologic response rate of 13%. As a group, interferon nonresponders who breakthrough while on interferon monotherapy seem to have a more favorable response rate to a repeat course of treatment. Retreatment with interferon and ribavirin for 6 months in nonresponders led to a sustained virologic response rate of 21%. Preliminary results from two trials in the United States demonstrate similar treatment efficacy. There is now evidence that maintenance interferon therapy may also be beneficial in interferon monotherapy nonresponders.

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References and Recommended Reading

  1. Kageyama F, Kobayashi Y, Murohisa G, et al.: Failure to respond to interferon-alpha 2a therapy is associated with increased hepatic iron levels in patients with chronic hepatitis C. Biol Trace Elem Res 1998. 64:185–196.

    PubMed  CAS  Google Scholar 

  2. Guyader D, Boucher E, Andre P, et al.: A pilot study of iron depletion as adjuvant therapy in chronic hepatitis C patients not responding to interferon. Am J Gastroenterol 1999, 94:1696–1698. ebotomy in 11 nonresponders improved ALT levels. It is unclear whether phlebotomy improves HCV RNA levels or histology.

    Article  PubMed  CAS  Google Scholar 

  3. Van Thiel DH, Friedlander L, Molloy PJ, et al.: Retreatment of hepatitis C interferon non-responders with larger doses of interferon with and without phlebotomy. Hepatogastroenterology 1996, 43:1557–1561.

    PubMed  Google Scholar 

  4. Tsai NC, Zuckerman E, Han SH, et al.: Effect of iron depletion on long-term response to interferon-alpha in patients with chronic hepatitis C who previously did not respond to interferon therapy. Am J Gastroenterol 1997, 92:1831–1834.

    PubMed  CAS  Google Scholar 

  5. Reddy KR, Hoofnagle JH, Tong MJ, et al.: Racial differences in responses to therapy with interferon in chronic hepatitis C. Hepatology 1999, 30:787–793. This report indicates that African Americans appear to have a high rate of nonresponse to interferon monotherapy, the cause of which is unknown.

    Article  PubMed  CAS  Google Scholar 

  6. Gish RG: Standards of treatment in chronic hepatitis C. Semin Liver Dis 1999. 19(suppl 1):35–47.

    PubMed  CAS  Google Scholar 

  7. Alberti A, Chemello L, Noventa F, et al.: Therapy of hepatitis C: re-treatment with alpha interferon. Hepatology 1997, 26(suppl 1):137S-142S.

    Article  PubMed  CAS  Google Scholar 

  8. Heathcote EJ, Keeffe EB, Lee SS, et al.: Re-treatment of chronic hepatitis C with consensus interferon. Hepatology 1998, 27:1136–1143. According to this report, retreatment with high-dose consensus interferon in nonresponders led to a 13% sustained virologic response rate.

    Article  PubMed  CAS  Google Scholar 

  9. Chow WC, Boyer N, Pouteau M, et al.: Re-treatment with interferon alfa of patients with chronic hepatitis C. Hepatology 1998, 27:1144–1148.

    Article  PubMed  CAS  Google Scholar 

  10. Heathcote EJ, James S, Mullen KD, et al.: Chronic hepatitis C virus patients with breakthroughs during interferon treatment can successfully be retreated with consensus interferon. Hepatology 1999, 30:562–566. As a group, interferon patients with breakthrough during initial interferon treatment seem to be more likely to have a sustained virologic response with retreatment, according to this report.

    Article  PubMed  CAS  Google Scholar 

  11. Davis GL, Esteban-Mur R, Rustgi V, et al.: Interferon alfa-2b alone or in combination with ribavirin for the treatment of relapse of chronic hepatitis C. N Engl J Med 1998, 339:1493–1499.

    Article  PubMed  CAS  Google Scholar 

  12. McHutchison JG, Gordon SC, Schiff ER, et al.: Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. N Engl J Med 1998 339:1485–1492.

    Article  PubMed  CAS  Google Scholar 

  13. Kwo PY, Pound DC, Fields S, et al.: Combination therapy with ribavirin plus alpha-interferon is beneficial for the treatment of chronic hepatitis C in patients who have failed treatment with alpha-interferon [abstract]. Gastroenterology 1999, 116:235A.

    Article  Google Scholar 

  14. Bacon BR, Rauscher JA, Smith-Wilkaitis NL, et al.: Interferonribavirin combination is successful in eliminating hepatitis C virus in non-responders to interferon alone including patients with normal aminotransferases [abstract]. Hepatology 1999, 30:372A.

    Article  Google Scholar 

  15. Barbaro G, Di Lorenzo G, Belloni G, et al.: Interferon alpha-2B and ribavirin in combination for patients with chronic hepatitis C who failed to respond to, or relapsed after, interferon alpha therapy: a randomized trial. Am J Gastroenterol 1999, 107:112–118. This report describes a sustained virologic response rate of 21% seen after a 6-month course of interferon and ribavirin. Preliminary results from other US trials suggest similar sustained response rates.

    CAS  Google Scholar 

  16. Perasso A, Testino G, Ansaldi F, et al.: r-Interferon alfa-2b/ribavirin combined therapy followed by low-dose r-interferon alfa-2b in chronic hepatitis C interferon nonresponders [letter; comment]. Hepatology 1999, 29:297–298.

    Article  PubMed  CAS  Google Scholar 

  17. Schiff ER, de Medina M, Kahn RS: New perspectives in the diagnosis of hepatitis C. Semin Liver Dis 1999, 19 (suppl 1):3–15.

    PubMed  Google Scholar 

  18. Gerotto M, Sullivan DG, Polyak SJ, et al.: Effect of retreatment with interferon alone or interferon plus ribavirin on hepatitis C virus quasispecies diversification in nonresponder patients with chronic hepatitis C. J Virol, 1999, 73:7241–7277.

    PubMed  CAS  Google Scholar 

  19. Chemello L, Cavalletto L, Donada C, et al.: Efficacy of a second cycle of interferon therapy in patients with chronic hepatitis C. Gastroenterology 1997, 113:1654–1659.

    Article  PubMed  CAS  Google Scholar 

  20. Shiffman ML, Hofmann CM, Contos MJ, et al.: A randomized, controlled trial of maintenance interferon therapy for patients with chronic hepatitis C virus and persistent viremia. Gastroenterology 1999, 117:1164–1172. This study examined patients with histologic but without virologic response to interferon. Thirty months of interferon at 3 million units three times weekly led to improved ALT levels as well as improved liver histology. No improvement was observed in virologic response.

    Article  PubMed  CAS  Google Scholar 

  21. Smith JP: Treatment of chronic hepatitis C with amantadine. Digest Dis Sci 1997, 42:1681–1687.

    Article  PubMed  CAS  Google Scholar 

  22. Younossi ZM, Perrillo RP: The roles of amantadine, rimantadine, ursodeoxycholic acid, and NSAIDs, alone or in combination with alpha interferons, in the treatment of chronic hepatitis C. Semin Liver Dis 1999, 19 (suppl 1):95–102.

    PubMed  CAS  Google Scholar 

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Kwo, P.Y. Treatment of chronic hepatitis C in nonresponders to interferon monotherapy. Curr Gastroenterol Rep 2, 11–17 (2000). https://doi.org/10.1007/s11894-000-0046-4

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