Better efficacy of a 12-month interferon alfa-2b retreatment in patients with chronic hepatitis C relapsing after a 6-month treatment: A multicenter,controlled, randomized trial

We studied the efficacy of three interferon alfa-2b (IFN-alpha 2b) regimens for the retreatment of patients with chronic hepatitis C (CHC) with prior complete response followed by relapse. Consecutive patients with CHC who ha d a complete biochemical response but relapse after a first course of 6 mon ths of IFN with 3 million units (MU) given subcutaneously three times per w eek were enrolled in the study. Six to 24 months after the end of the first treatment, the patients were randomly assigned to receive IFN with either the same regimen (group 1), a regimen of 12 months with 3 MU (group 2), or a regimen of 6 months with 10 MU (group 3). Sustained biochemical response was defined as normal serum alanine transaminase (ALT) values during the fo llow-up and sustained virological response as a clearance of hepatitis C vi rus (HCV) RNA from the serum at the end of follow-up (6 months' posttreatme nt). Histological improvement was defined as a decrease of 1 point in Metav ir score between the first liver biopsy and a biopsy performed at 6 months' postretreatment. Two hundred forty-seven patients were randomized: 75 to g roup 1, 91 to group 2, and 81 to group 3. In an intent-to-treat analysis, 1 2%, 36.3%, and 18.5% of patients had a sustained biochemical response after retreatment in groups i, 2, and 3, respectively (P <.001); 13.8%, 32.4%, a nd 17.2% of patients had a sustained virological response after retreatment in groups i, 2, and 3, respectively (P <.05). A low viral load and patient s in group 2 were independently associated with a sustained biochemical res ponse. A low Knodell score index before treatment, patients with a high lev el of ALT before retreatment, genotype 3, low viral load, and patients in g roup 2 were independently associated with sustained virological response. Y ounger age, a high level of ALT, a low level of gamma-glutamyl transferase before retreatment, low viral load, and patients in group 2 were independen tly associated with sustained biochemical and virological response. Among t he 80 patients with repeated liver biopsies, 47.6% had improved histologica l activity scores; this improvement was associated with a sustained biochem ical and virological response. In patients with CHC initially treated with 3 MU of IFN given subcutaneously three times per week over a 6-month period , and who subsequently developed a relapse after a biochemical response, re treatment with a regimen of 3 MU of IFN given three times per week for 12 m onths produced better biochemical and virological sustained response rates than regimens involving a higher dose or a shorter duration of retreatment. The biochemical and virological sustained response was associated with his tological improvement.