Background: Treatment options for hepatitis C have developed rapidly in the past decade. The current treatment of choice is a combination of pegylated-interferon-α (PEG-IFN-α) and ribavirin. With the development of more therapy options, patients who failed in prior therapy hope to clear hepatitis C virus by undergoing a more effective retreatment regime. In this report, we investigated response rates to combination therapy [standard IFN-α or PEG-IFN-α and ribavirin] in patients who relapsed or failed in prior therapy.
Methods: Ninety-three patients were included in this retrospective study. All patients failed to previous IFN-α monotherapy (n=55) or to a combination of standard IFN-α and ribavirin (n=38). Fifty-nine patients were nonresponders and 34 were relapsers. Thirty-five patients were retreated with standard IFN-α plus ribavirin and 58 received PEG-IFN-α combination therapy.
Results: Sustained virologic response (SVR) was induced in 31% of all patients. The highest SVR rate (58%) was observed in relapsers to standard IFN-α combination therapy who were retreated with PEG-IFN-α combination therapy. The SVR rate in relapsers to standard IFN-α monotherapy who received a standard IFN-α combination therapy was 50%. Relapsers responded in a significantly higher proportion to retreatment than nonresponders (56% vs. 17%, P<0.001). Relapse to previous therapy was identified as an independent predictor for therapy response. The lowest SVR rate was observed in nonresponders to standard IFN-α combination therapy who were retreated with PEG-IFN-α combination therapy (1/26; 4%).
Conclusions: In relapsers, retreatment with the most effective therapy regime to date a combination of PEG-IFN-α and ribavirin, is promising. However, retreatment with PEG-IFN-α combination therapy in nonresponders to standard IFN combination therapy is not effective.