Modified Interferon Effective Against Hepatitis C


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Wednesday December 6 5:29 PM ET
Modified Interferon Effective Against Hepatitis C

NEW YORK (Reuters Health) - A modified form of interferon, the preferred therapy for hepatitis C, is more effective than ordinary interferon, according to two new reports.

Although interferon, which is usually given in combination with the drug ribavirin, can suppress levels of the hepatitis C virus (HCV), the treatment provides long-lasting benefits to fewer than 20% of patients who receive it.

In addition, the drug can cause serious side effects.

Since the drug does not remain in the body for long, it is usually taken three times a week. But a process called pegylation, in which another molecule is joined to interferon, produces peginterferon alfa-2a, which stays in the body longer so patients only have to take it once a week.

In the first of two articles published in the December 7th issue of The New England Journal of Medicine (news - web sites), an international team of researchers reports that peginterferon alfa-2a is significantly more effective than unmodified interferon at keeping HCV in check.

The study included 531 patients infected with HCV who were randomly assigned to receive either unmodified interferon three times a week or peginterferon alfa-2a once a week for 48 weeks.

At 48 weeks, HCV levels were undetectable in 69% of the peginterferon alfa-2a group, compared with 28% of the interferon group, according to researchers led by Dr. Stefan Zeuzem, of the Klinikum der Johann Wolfgang Goethe Universitat in Frankfurt, Germany.

Twenty-four weeks after the patients stopped the treatment, levels of the virus were still undetectable in 39% of people who had taken the modified version of interferon, compared with 19% of those who had taken the unmodified form.

The frequency and nature of side effects were similar in both groups, the report indicates.

``Peginterferon alfa-2a is a safe and effective treatment for HCV infection,'' Zeuzem and colleagues conclude.

``Frequently in medicine, more effective treatments are associated with more side effects,'' Zeuzem told Reuters Health. This is not the case with peginterferon alfa-2a, he explained.

``In addition, the patients will appreciate that this drug has to be injected only once per week instead or daily or thrice weekly,'' he said.

In the second study, researchers led by Dr. E. Jenny Heathcote, of Toronto Western Hospital in Canada, report that peginterferon alfa-2a is more effective than ordinary interferon in patients with HCV who have already developed cirrhosis or some scarring of the liver. Normally, anti-HCV treatment can cause extremely serious side effects in people who have already developed liver scarring.

Their study included 271 people with fibrosis or cirrhosis who received one of three treatments for 48 weeks: low-dose peginterferon alfa-2a once a week, high-dose peginterferon alfa-2a once a week or unmodified interferon three times a week. After treatment ended, the researchers followed the participants for another 24 weeks.

At the end of 72 weeks, HCV levels were undetectable in 8% of patients in the interferon group, 15% of those in the low-dose peginterferon alfa-2a group and 30% of people who took the high dose of peginterferon alfa-2a.

The rate of side effects was similar in all three treatment groups, but patients taking high-dose peginterferon alfa-2a were somewhat more likely to drop out of the study due to side effects.

The results of the studies suggest that peginterferon alfa-2a may be a promising treatment for HCV, according to Drs. Daniel F. Schafer and Michael F. Sorrell, of the University of Nebraska Medical Center in Omaha.

However, they note in an editorial that accompanies the study that a higher percentage of Americans than in the studies are infected with a strain of HCV that is more resistant to treatment. The editorialists also note that the trials contained few black participants, who might respond differently to the treatment.

Both studies were funded by F. Hoffmann-LaRoche, the Swiss company that makespeginterferon alfa-2a. The drug is not currently approved for use in the US.

SOURCE: The New England Journal of Medicine 2000;343:1666-1680, 1723

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