• combination therapy;
  • double filtration plasmapheresis;
  • early viral reduction;
  • non-responder;
  • relapser;
  • sustained virus response

Aim:  The efficacy and safety of double filtration plasmapheresis (DFPP) plus interferon (IFN) combination therapy were compared with those of IFN therapy alone in 193 chronic hepatitis C patients having a high hepatitis C virus ribonucleic acid load of difficult-to-treat genotype 1b.

Methods:  All patients received either interferon alpha-2b (IFN-α-2b) monotherapy or combination therapies with ribavirin and IFN-α-2b or pegylated interferon alpha-2b (PEG-IFN-α-2b). Each patient individually decided whether to receive concomitant DFPP. DFPP was immediately followed by IFN treatment, and up to five sessions were given during the first week.

Results:  Sixty patients decided to receive DFPP. In the DFPP plus PEG-IFN-α-2b therapy group (n = 30), viral load reduction at 4 weeks after the start of treatment was greater than innon-DFPP (n = 74) (2.47 vs 1.52, log, P = 0.010), and the sustained virus response was also higher (77.8% vs 50.0%), even in cases of re-treated patients (relapsers or non-responders to previous IFN therapies). Adverse events, mild and transient, were observed in 38.3% of all DFPP-treated patients.

Conclusion:  DFPP plus IFN combination therapy produced a great reduction of viral load during the early stage of treatment and achieved a high sustained virus response, suggesting that this combination therapy may be a new modality for chronic hepatitis C patients at difficult-to-treat states.