The pattern of response to interferon alpha (alpha-IFN) predicts sustainedresponse to a 6-month alpha-IFN and ribavirin retreatment for chronic hepatitis C

Background/Aims: In chronic hepatitis C, interferon-alpha (alpha-IFN) and r ibavirin combination therapy improves sustained response compared to alpha- IFN monotherapy, both in naive patients and in previous alpha-IFN relapsers , but the efficacy of such therapy remains limited in non-responder cases. The aim of this study was to assess whether the pattern of response to alph a-IFN alone may predict sustained response to combination therapy during re treatment, Methods: Fifty previous alpha-IFN relapsers and 50 previous alpha-IFN non-r esponders were retreated with a high alpha-IFN dose (6 MU/thrice weekly for 2 months; induction phase) and then randomised to continue with alpha-IFN alone (3 MU/thrice weekly) or to receive combination therapy (3 MU/thrice w eekly of a alpha-IFN and 1000-1200 mg/daily of ribavirin) for an additional 6 months according to the biochemical response to alpha-IFN shown after th e induction phase, All patients were also evaluated for virological and his tological response. Results: Eleven of 25 (44%) relapsers treated with combination therapy and 4/25 (16%) treated with alpha-IFN alone achieved a sustained response. The corresponding figures among non-responders were 1/25 (4%) and 0/25, respect ively, Among 26 patients with a complete ALT and HCV-RNA response after 2 m onths of alpha-IFN, sustained response was seen in 11/14 (79%) treated with combination therapy and in 4/12 (33%) treated with alpha-IFN alone (p=0.05 ). On the other hand, of 74 cases still HCV-RNA positive after 2 months of alpha-IFN alone, biochemical and virological end of therapy response was be tter with combination therapy (11/36; 30.5%) compared to alpha-IFN alone (4 /38; 10.5%), but only one patient developed a sustained response (1/36; 3%) . Conclusions: The retreatment with a 6-month combination therapy was associa ted with a high rate of sustained response only in patients showing a compl ete biochemical and virological response to alpha-IFN alone. Longer retreat ment with combination therapy may be needed to achieve a sustained response in patients without a prompt virological response to alpha-IFN.