RETREATMENT OF CHRONIC HEPATITIS-C WITH INTERFERON-ALPHA AND RIBAVIRIN IN NONRESPONDERS TO INTERFERON-ALPHA MONOTHERAPY - ANALYSIS OF THE OWN EXPERIENCE AND REVIEW OF THE LITERATURE

Combination therapy of chronic hepatitis C with interferon alpha and r ibavirin has been proven to be highly effective in naive and relapse p atients with two to ten-fold increase of the response rate. However. c ombination therapy of primary non-responders to interferon alpha is di scussed controversially Therefore? to analyze the response rate to ret reatment with a combination therapy with interferon alpha and ribaviri n; we compared data of 555 patients described in 23 publications to th e data of 16 non-responders treated in our center. The patients receiv ed interferon alpha (at least 3 MU tiw) and ribavirin in a dose of 1,0 00/1,200 mg per day. At the end of treatment 14% of our patients had n ormal ALT values and were HCV-RNA-negative compared to 34% of all pati ents described in the literature. In our patients the viral load decre ased from 1,110 +/- 670 x 10(3) copies/ml prior to therapy to 300 +/- 480 x 10(3) copies/ml at the end of treatment (p = 0.002). After a fol low-up period of six months quantitative RNA-levels rose again to 1,48 5 +/- 755 x 10(3) copies/mi. Whereas only 7.4% (24/325) of all patient s described showed a response with normal ALT values and negative HCV- RNA at the end of follow-up, no sustained response was observed. in ou r patients. In contrast to naive and relapse patients, the response ra te of combination therapy in patients previously not responding to int erferon alpha alone is only low. Thus, standard re gime (IFN 3MU tiw p lus ribavirin for six months) as a regular therapy for non-responders is not recommended.