T. Poynard et al., Is an "a la carte" combination interferon alfa-2b plus ribavirin regimen possible for the first line treatment in patients with chronic hepatitis C?, HEPATOLOGY, 31(1), 2000, pp. 211-218
Randomized trials have shown the enhancement of efficacy with interferon al
fa-2b and ribavirin (IFN-R) in comparison with interferon monotherapy (IFN)
as first line treatment of chronic hepatitis C. Further definition of resp
onse based on disease, patient, and treatment characteristics is needed to
determine the degree of benefit for the various patient subgroups. The aim
of this study was to answer this question by analyzing the data from 1,744
naive patients included in trials that compared 24- or 48-week IFN-R treatm
ent. Response factors were identified by logistic regression and receiver o
perating characteristics curves. Five independent characteristics were asso
ciated with a sustained loss of hepatitis C virus (HCV) RNA (<100 copies/mL
) 24 weeks after the end of treatment: genotype 2 or 3, baseline viral load
less than 3.5 million copies/mL, no or portal fibrosis, female gender, and
age younger than 40 years, There was a significant advantage for IFN-R in
comparison with IFN alone whatever the combination of factors. The most eff
icient strategy is to treat all patients for 24 weeks, If the 24-week polym
erase chain reaction (PCR) is positive, treatment can be stopped, If the 24
-week PCR is negative, patients with fewer than 4 favorable factors should
be treated for an additional 24 weeks. Conclusion: The combination of IFN-R
is better as first line treatment than IFN monotherapy, For patients who a
re PCR-negative after 24 weeks of treatment, genotyping and baseline viral
load, fibrosis stage, gender, and age are useful predictive factors in dete
rmining whether to continue an additional 24 weeks of treatment.