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Efficacy of interferon alpha-2b induction therapy before retreatment for chronic hepatitis C

Authors


Correspondence
Robert G. Gish, MD, California Pacific Medical Center, 2340 Clay St., Room 223, San Francisco, CA 94115.
Tel: +415 600 1020
Fax: +415 776 0292
e-mail: gishr@sutterhealth.org

Abstract

Background/Aims: Chronic hepatitis C (HCV) patients who have failed previous treatment have low sustained viral response (SVR) rates with repeat treatment. We evaluated whether interferon (IFN) induction during retreatment improves response rates.

Methods: Two randomized, controlled trials were conducted in chronic HCV patients who failed IFN. In Study 1, patients received IFN 3 MU daily plus ribavirin (RBV) 1000 mg/day for 4 weeks, followed by IFN 3 MU TIW plus RBV 1000 mg/day for 44 weeks (induction; n=232), or IFN 3 MU TIW plus RBV 1000 mg/day for 48 weeks (non-induction; n=237). In Study 2, patients received IFN 5 MU B.I.D. plus RBV 1000–1200 mg/day for 2 weeks, followed by pegylated IFN (PEG-IFN) 75–150 μg weekly plus RBV 1000–1200 mg/day for 46 weeks (induction; n=201), or PEG-IFN 75–150 μg weekly plus RBV 1000–1200 mg/day for 48 weeks (non-induction; n=206). The primary end point for both trials was SVR.

Results: Induction did not increase SVR compared with non-induction, but did increase the on-treatment response among genotype non-1 patients in Study 2. By intention-to-treat (ITT) analysis, SVR in Study 1 was 13% for induction vs. 9% for non-induction (P=NS). In Study 2 (ITT), SVR was 20% for induction vs. 24% for non-induction (P=NS). However, by non-ITT analysis of Study 2, genotype non-1-previous non-responders showed significantly higher response rates with induction than non-induction.

Conclusion: For chronic HCV patients who have failed IFN, induction with retreatment does not improve SVR, but may be beneficial for patients with genotype non-1 HCV.

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