Interferon retreatment in chronic hepatitis C: which patients to choose, and what schedule to use

Objective. To evaluate the results of a large cohort of nonresponder or rel apsing responder patients with chronic hepatitis C retreated with various s chedules of interferon (IFN). Methods. Our study included 276 patients (158 nonresponders and 118 relapsi ng responders) who underwent IFN retreatments. Among the non-responder grou p, 158 patients underwent further courses of IFN, In particular, 108 patien ts underwent one course of IFN retreatment, 40 patients underwent two cours es, eight patients underwent three courses, and two patients underwent four courses. Regarding the relapsing responder group, the 118 patients were re treated with the same dosage for varying periods. In particular, 50 patient s were treated for 6 months, 43 patients for 12 months, and 25 for 24 month s. Patients in the subgroups of IFN retreatment were homogeneous as far as age and gender distribution, as well as virological and histological charac teristics, are concerned. Qualitative and quantitative HCV-RNA was evaluate d at baseline, at the end of treatment and at the last check-up of follow-u p. HCV genotype was determined on baseline serum samples. Alanine transamin ase (ALT) levels were tested monthly. Results. Long-term biochemical (normal ALT levels) and virological (HCV-RNA negative) response was obtained in 2.6% of non-responder retreated patient s, and in 33.9% of relapsing responder retreated patients. Evaluation of re sponse on the basis of the duration of treatment showed that 48%, 19% and 1 6% of relapsing responder patients retreated for 24, 12 and 6 months, respe ctively, obtained long-term biochemical and virological response. Conclusion. Non-responder patient retreatment is inefficient especially in cirrhotic and/or genotype Ib patients. IFN retreatment is warranted in rela psing responder patients, In particular, 24-month therapy induces significa nt long-term biochemical and virological response. Eur J Gastroenterol Hepa tol 11:649-653. (C) 1999 Lippincott Williams & Wilkins.