Therapy of chronic hepatitis C: a critical review.
Combination therapy (Interferon plus ribavirin) is the current therapeutic gold standard for naive Hepatitis C Virus (HCV)-positive patients and with the recent advent of pegylated (PEG) IFN the rate of the sustained virological response (HCV-RNA clearance 6 months after the end of treatment) is about 54%-56% with a therapeutical gain mainly among patients with unfavourable HCV genotype (1a, 1b); in this subset of patients, a 42%-46% sustained response rate is achieved compared with 33%-36% found among genotype 1 patients treated with the standard therapy. Patients who respond to IFN monotherapy but relapse during the follow-up should be re-treated with combination therapy given for at least 6 months at the minimum dose of 3 MU thrice weekly plus ribavirin 1000 mg/daily. Recent data suggest that prolonging the time of treatment (12 months) may induce a significantly higher rate of sustained response among patients with genotype 1. The efficacy of the combination of IFN and ribavirin in retreating patients with chronic hepatitis C not responding to IFN monotherapy is controversial as it ranges between 0% and 40%. Recent data show an overall rate of sustained response of 23% when an aggressive approach is adopted but increasing the dosage and the time of treatment induces a significant therapeutic benefit only in patients with genotype 1. In conclusion, a therapeutic progress for chronic hepatitis C has been achieved during the last 10 years (56% vs 20% of sustained response rate obtained with IFN monotherapy) but several unresolved issues are yet to be addressed.
Saracco
G
G
Department of Gastroenterology, Molinette Hospital, Torino, Italy. g.saracco@tin.it
Olivero
A
A
Ciancio
A
A
Carenzi
S
S
Rizzetto
M
M
D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D025861:Blood Coagulation Disorders, Inherited / Q000150:complications; D003866:Depressive Disorder / Q000150:complications; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome
D016898:Interferon-alpha; D012254:Ribavirin; D000410:Alanine Transaminase