What to do when standard therapy fails


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Forum (Genova) 2000 Jan-Mar;10(1):63-9
Buti M, Esteban R; University General Hospital Valle de Hebron, Barcelona, Spain.

An important group of patients with chronic hepatitis C do not respond to interferon (IFN) therapy.

Compared with untreated patients with chronic hepatitis C, non-responders have a higher percentage of cirrhosis, are more frequently infected by genotype 1 and usually have a viral load above 2 x 106 copies/ml.

Also, patients with cirrhosis have lower life expectancy and higher risk of clinical complications, and therefore, are most in need of effective treatment strategies.

There is no evidence that the re-treatment of non-responders with a standard regimen of IFN or more prolonged IFN therapy achieves a sustained biochemical or virological response.

Between 20% and 40% of non-responder patients treated with IFN therapy for more than two years had an hepatic improvement in liver histology associated with a decrease in hepatitis C virus-ribonucleic acid levels.

In contrast, combination therapy with IFN and ribavirin for six months now results in sustained response rates between 6% and 29% depending on the viral genotype and the presence or absence of cirrhosis.

Patients infected with genotype 2 and 3 have a higher probability of achieving a sustained virological response than those infected by genotype 1.

Currently, different studies are underway to determine whether high-dose IFN and/or induction therapy combined with ribavirin for more prolonged periods of time could increase the sustained response rate in non-responders.

No other drugs appear to be efficacious in these patients, except the combination of IFN, ribavirin and amantadine which has shown interesting results in a preliminary trial but they need to be confirmed in further studies.

These findings suggest that combination therapy is beneficial and can be recommended for some non-responder patients until other new therapies are available.

Publication Types: Review, tutorial; PMID: 10717258, UI: 20184085

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