The treatment of hepatitis C: history, presence and future.
The treatment of chronic hepatitis C has made remarkable progress over the past two decades. For interferon-alpha monotherapy, sustained virological response rates were between 2 and 9% in genotype 1 and between 16 and 23% in genotypes 2 and 3. By adjusting treatment duration up to 48 weeks for genotype 1 and combining regular interferon-alpha with ribavirin, sustained response rates could be improved to 28 to 31% in genotype 1 and around 65% in genotypes 2 and 3. Attempts to further increase efficacy included the addition of amantadine without conclusive evidence up till now. With the recent introduction of long-acting pegylated interferon-alpha in combination with ribavirin, sustained virological response rates of 8o% can be obtained in genotypes 2 and 3. However, sustained virological response rates for patients with either genotype 1, nonresponse to prior treatment, cirrhosis or a combination of these characteristics are still less than 50%. In view of results with daily high-dose interferon-alpha induction in combination with prolongation of treatment duration up to 18 months, such patients might benefit from induction and prolonged PEG-IFN-alpha treatment and should be treated in an experimental setting.
Vrolijk
J M
JM
Department of Gastroenterology and Hepatology (Ca326), Erasmus Medical Centre, Rotterdam, the Netherlands.
de Knegt
R J
RJ
Veldt
B J
BJ
Orlent
H
H
Schalm
S W
SW
D000547:Amantadine / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D002908:Chronic Disease; D032921:Consensus; D004359:Drug Therapy, Combination; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012254:Ribavirin / Q000627:therapeutic use
D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin; D000547:Amantadine