What's Next When Treatment of Hepatitis C Fails?


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Physicians are seeing more patients who have failed treatment for hepatitis C virus (HCV) infection. And they are faced with the difficult decision of what to do next for these people. Since there are no ideal, uniformly effective treatments for the disease, as more people are treated, more relapse or never respond at all.

For previously untreated patients, the most commonly prescribed therapy for chronic HCV in the United States is combination therapy with interferon (Intron A, Schering) plus ribavirin. According to Raymond Koff, MD, Chairman of Medicine at the University of Massachusetts Medical School, treatment success was only 38% for patients given combination therapy for 48 weeks, and 31% for 24 weeks. Success with interferon alone for 48 and 24 weeks was 13% and 6%, respectively.

In a special symposium held during the recent Digestive Disease Week (DDW) meeting in Orlando, Florida, leading hepatitis researchers presented data to try to answer the question of "what next?" One experimental strategy is to switch drugs, using consensus interferon (Infergen, Amgen) for people who failed combination therapy. UCLA's Dr. Paul Martin calls this approach one of the "most promising." He calls retreatment with the same regimen "generally futile."

Another strategy is to use drugs at higher doses or administered more frequently, so-called "induction therapy." Tse-Ling Fong, MD of Cedars-Sinai Medical Center in Los Angeles is conducting a study using consensus interferon at higher doses to treat 300 patients who failed previous interferon mono- or combination therapy. "The goal of our study is to determine the efficacy and tolerability of induction therapy – higher doses and increased frequency – daily dosing over a twelve week regimen," Dr. Fong said. A similar study headed by Dr. Maria Sjogren at Walter Reed Army Medical Center in Washington, DC is now enrolling 400 patients.

Thousands of patients began combination therapy in October of last year, when the treatment was approved for use. Dr. Koff concluded the symposium saying, "By fall, we will be seeing people who have completed a year of therapy," noting that "60% to 90% of them are going to be non-responders or will have relapsed."

"So we're desperate for the information that will come out of these trials," he said.

Highlights of these studies and several others from the DDW meeting are available at http://www.highlights.wellweb.com.

Distributed by: Patients NewsWire

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