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High-dose
Induction Therapy with Interferon Alfa-2b (PegIntron) Plus
Ribavirin for Treatment of Relapsers or Nonresponders
The aim of the current study was to evaluate
daily high-dose induction therapy with interferon-alfa-2b
(PegIntron; IFN-alfa-2b)
in combination with ribavirin for the treatment of patients who failed
with interferon monotherapy and had a relapse, based on the
assumption that the viral burden would decline faster, thus
increasing the likelihood of higher response rates in this
difficult-to-treat patient group.
Seventy
patients were enrolled in this study. Treatment was started
with 10 MU IFN-alfa-2b daily for 3 wk, followed by IFN-alfa-2b
5 MU/TIW in combination with ribavirin (1 000-1 200 mg/d) for
21 wk. In case of a negative HCV RNA PCR, treatment was continued
until wk 48 (IFN-alfa-2b 3 MU/TIW+1 000-1 200 mg ribavirin/daily).
Results
· The
dose of IFN-alfa-2b or ribavirin was reduced in 16% of patients
because of hematologic
side effects, and treatment was discontinued in 7% of patients;
· An
early
viral response (EVR) was achieved in 60% of patients;
· Fifty
percent of all patients achieved an end-of-treatment
response (EOT)
and 40% obtained a sustained viral response (SVR);
· Patients
with no response had a significantly lower response rate than
those with a former relapse
(SVR 30% vs 53%; P = 0.049);
· Furthermore,
lower response rates were observed in patients infected with
genotype
1a/b
than in patients with non-1-genotype (SVR 28% vs 74%; P = 0.001);
· A
rapid initial decline of HCV RNA was identified as a significant
predictive factor for a sustained response;
· No
patients achieving a negative HCV-RNA PCR at wk 18 or later
eventually eliminated the virus.
In
conclusion, the authors write, “Daily high-dose induction
therapy with interferon-alfa-2b is well tolerated and effective
for the treatment of non-responders and relapsers, when interferon
monotherapy fails.”
“A
fast decline of viral load during the first 12 wk is strongly
associated with a sustained viral response.”
Department of Gastroenterology and Hepatology, University of
Tuebingen, Tubingen, Germany.
09/19/05
Reference
H G Hass and others. High-dose interferon-alpha2b induction therapy
in combination with ribavirin for treatment of chronic hepatitis
C in patients with non-response or relapse after interferon-alpha
monotherapy. World
Journal of Gastroenterology
11(34):5342-5346. September 14, 2005.
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