RETREATMENT OF HEPATITIS-C INTERFERON NONRESPONDERS WITH LARGER DOSESOF INTERFERON WITH AND WITHOUT PHLEBOTOMY

Background/Aims: Interferon a (IFN) is the only agent currently approv ed by the FDA for the treatment of chronic viral hepatitis due to hepa titis C (HCV). Unfortunately, less than half the patients with HCV tre ated with IFN respond. Worse yet, half or more of those who do respond relapse when the agent is withdrawn. Materials and Methods: In this p rospective randomized study, 30 individuals who had failed to respond to a standard course of IFN therapy consisting of 3 MU IFN administere d 3 x week for 6 months were randomized to receive a second 6 month co urse of either 5 MU IFN daily or 5 MU IFN plus regular phlebotomies at weekly intervals to achieve a hemoglobin level of between 10-11 g/dl. The response rates defined as HCV-RNA negativity after 6 months of th erapy and after 6 months of follow-up without IFN were determined. Res ults: Both groups experienced a significant reduction in their serum A LT levels (p <0.01) and Knodell scores with treatment. A greater numbe r of responders were found in the phlebotomy plus IPN group than in th e IFN alone group whether the response was defined by the serum ALT le vel or presence or absence of HCV-RNA in serum at the end of treatment and follow-up. Conclusions: The results of this study suggest that bo th an increased IFN dose coupled with more frequent dosing of IFN alon e and combined with phlebotomy treatment are effective at obtaining a response to IFN in individuals with HCV disease who previously have fa iled to respond to a standard treatment regimen.