Interferon alfa with or without ribavirin for chronic hepatitis C: systematic review of randomised trials.
OBJECTIVE
To assess the efficacy and safety of interferon alfa with or without ribavirin for treatment of chronic hepatitis C.


METHODS
Systematic review of randomised trials on interferon alfa plus ribavirin combination therapy versus interferon alfa. Patients were naive (not previously treated with interferon), relapsers (transient response to previous interferon therapy), or non-responders (no response to previous interferon therapy).


METHODS
Of 1155 references identified, 48 trials with 6585 patients met the inclusion criteria. Patients were followed to the end of treatment in 20 trials and in 28 trials for 12-96 weeks after treatment.


METHODS
Virological response and morbidity plus mortality.


RESULTS
Compared with interferon, combination therapy reduced the risk of not having a sustained virological response for 6 months by 26% in naive patients (relative risk 0.74, 95% confidence interval 0.70 to 0.78), 33% in relapsers (0.67, 0.57 to 0.78), and 11% in non-responders (0.89, 0.83 to 0.96). Morbidity and mortality showed a non-significant trend in favour of combination therapy (Peto odds ratio 0.45, 0.19 to 1.06). Combination therapy significantly reduced the risk of not having improvement in results of histology by 17% in naive patients (0.83, 0.74 to 0.93) and by 27% in relapsers and non-responders (0.73, 0.66 to 0.82). The risk of treatment discontinuations was significantly higher after combination therapy (1.28, 1.07 to 1.52).


CONCLUSIONS
Treatment with interferon alfa plus ribavirin has a significant beneficial effect on the virological and histological responses of patients with chronic hepatitis C, irrespective of previous treatment. Combination therapy may therefore also be considered appropriate for relapsers and non-responders.
Kjaergard
L L
LL
Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Center for Clinical Research, Rigshospitalet, DK-2100, Copenhagen, Denmark. k.jaergard@ctu.rh.dk
Krogsgaard
K
K
Gluud
C
C
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D009017:Morbidity; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use*; D012306:Risk
D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin