HCV RNA levels during therapy with amantadine in addition to interferon and ribavirin in chronic hepatitis C patients with previous nonresponse or response/relapse to interferon and ribavirin

Interferon (IFN) alpha in combination with ribavirin (RIB) is standard ther apy for patients with chronic hepatitis C virus (HCV) infection, However, m any patients do not respond with sustained HCV clearance to this therapy. A t present, no accepted treatment strategy exists for these patients. Recent preliminary data have suggested that amantadine (AMA) is effective against HCV infection. In a pilot study, we treated 13 nonresponders and 10 respon se/relapsers to previous IFN/RIB therapy with AMA 200 mg per day in combina tion with IFN 3 MU thrice weekly, and RIB 1000 mg per day for 24 weeks, wit h a 24-week follow-up period after end-of-treatment. At the end-of-treatmen t, 1 previous nonresponder and 5 previous response/relapsers were HCV RNA n egative. At the end of follow-up, only 1 previous response/relapser remaine d HCV RNA negative and had a sustained response. During therapy, serum HCV RNA became undetectable in 4 previous nonresponders, of whom 3 had a breakt hrough at week 24, Twenty-one patients continued therapy without dose reduc tions. One patient discontinued therapy prematurely due to sleeping disturb ances, and another patient was withdrawn from therapy due to heavy alcohol intake. We conclude that the addition of AMA to IFN and RIB was well tolera ted but had little, if any, impact on HCV RNA eradication in nonresponders or response/relapsers to previous IFN/RIB combination therapy.