2005 Mar;6(3):399-408. Related Articles, Links

Treatment of hepatitis C: critical appraisal of the evidence.

Camma C, Licata A, Cabibbo G, Latteri F, Craxi A.

University of Palermo, Cattedra di Gastroenterologia, Istituto di Clinica
Medica, Italy. camma@...

Chronic hepatitis C virus infection is currently the most common cause of end
stage liver disease worldwide. Although the conclusions of the last National
Institutes of Health Consensus Development Conferences on Hepatitis C have
recently been published, several important issues remain unanswered. This paper
reviews the available data using an evidence-based approach.

Current evidence is sufficient to recommend IFN treatment for all
patients with acute hepatitis. A later initiation of therapy yields the same
likelihood of response as early treatment. A daily induction dose during month 1
is the best treatment option.

The current gold standard of efficacy for treatment-naive patients with chronic
hepatitis C is the combination of pegylated IFN and ribavirin. The overall
sustained viral response rate to these regimens is 54 - 56% following a 48-week
course of therapy.

Patients with genotype 1 infection will have a 42 - 51% likelihood of response
to 48 weeks of therapy. Those with genotypes 2 or 3 infection will respond to 24
weeks in 78 - 82% of cases.

Debate continues regarding the optimal dose and duration of peginterferon
(PEG-IFN), not only in patients infected with genotype 2 or 3 but also in those
infected with genotype 1. The optimal dose of ribavirin has yet to be
determined.

Available data show the need to give the highest tolerable
doses (1000-1200mg/day) to the difficult-to-treat patients (genotype 1,
cirrhotics, obese), although there is a greater likelihood of intolerance.

Genotypes 2 and 3 may receive 800mg/day, which is also the most appropriate
lower dose for those patients who require dosage modification for anaemia or
other side effects. Tolerability and compliance to therapy are still a problem,
as approximately 15- 20% of patients within trials and > 25% in clinical
practice withdraw from therapy.

New PEG-IFNs are more effective than conventional IFN in improving liver
histology. Monotherapy with PEG-IFN induces a marked reduction in staging in
virological sustained responders, and to a lesser degree in relapsers, but
provides no benefit to nonresponders after 24-48weeks of treatment.

The use of maintenance therapy in virological nonresponders aiming to
improve histology should be considered experimental and of unproven
benefit.

Pooling data from the literature suggests a slight preventive effect of IFN on
hepatocellular carcinoma development in patients with HCV-related cirrhosis. The
magnitude of this effect is low and the observed benefit may be due to spurious
associations. The preventive effect is more evident among sustained responders
to IFN.

PMID: 15794731 [PubMed - in process]

Source URL:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\
ct&list_uids=15794731




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