Comparison of thrice weekly vs daily human leucocyte interferon-alpha therapy for chronic hepatitis C

Standard treatment for chronic hepatitis C currently consists of 3-6 millio n units (MU) of interferon-alpha (IFN-alpha) given thrice weekly (t.i.w.) f or 12 months, obtaining rates of sustained response (SR) that usually do no t exceed 15-25%, Some recent reports have suggested that daily administrati on of IFN-alpha may be more efficacious, More than 7 years ago, when standa rd therapy for hepatitis C was usually given for 6 months, we conducted a r andomized clinical trial comparing daily vs t.i.w, treatment, In this study , 149 patients with chronic hepatitis C were randomized to received 3 MU of IFN-alpha either t.i.w. for 6 months or daily for 3 months followed by t.i .w. for 3 months, All patients were treated with human leucocyte IFN-alpha and were followed-up for up to 72 months after inclusion. Overall, patients treated daily or t.i.w, had similar rates of virological response after 3 months of induction [24/49 (50%) vs 40/100 (40%)], at the end of therapy [1 5/49 (31%) vs 36/100 (36%)] and at the end of follow-up [6/49 (12%) vs 9/10 0 (9%)], However, when patients infected with HCV types other than HCV-1 we re studied, there was a trend favouring the daily schedule that was associa ted with a higher [5/20 (25%) vs 5/48 (10%)] rate of long-term SR. All pati ents with a virological response - hepatitis C virus (HCV) RNA negative in serum as determined using the polymerase chain reaction - at 6 months after therapy remained in biochemical and virological remission at long-term fol low-up, while seven of eight subjects who had normal alanine aminotransfera se (ALT) levels but were serum positive for HCV RNA at 6 months, relapsed l ater, indicating that serum HCV RNA is better than ALT at predicting longte rm cure after IFN-alpha therapy in chronic hepatitis C.