title: Ribavirin priming in patients with chronic hepatitis C and normal ALT: a pilot study.
abstract: OBJECTIVE
  Ribavirin has favorable immune-modulating effects in patients with hepatitis C. Therefore, a ribavirin monotherapy preceding the combination of peginterferon plus ribavirin may be beneficial. We conducted a pilot study with a sequential regimen using a reduced dosage of peginterferon-alfa 2b in patients with chronic hepatitis C and normal transaminases.
  
  
  METHODS
  Twenty patients (17 genotype 1, 3 genotype 2/3) were treated with ribavirin for 4 wk followed by ribavirin plus peginterferon-alfa 2b 100 microg for 4 wk and ribavirin plus peginterferon-alfa 2b 50 microg for 44 wk. TH1-cytokines interferon-gamma and interleukin-2, and TH2-cytokines interleukin-4 and interleukin-10 were measured in the supernatant from PHA-stimulated lymphocytes.
  
  
  RESULTS
  Sustained viral response defined as negative HCV-RNA after follow up was 50%, 41%, and 100% for all patients, genotype 1, and genotype 2/3, resp. The increase in interferon-gamma following ribavirin monotherapy was significantly higher for patients with sustained viral response.
  
  
  CONCLUSIONS
  The sustained viral response rate of this pilot study using ribavirin priming and reduced peginterferon dosage is in line with previous trials using standard treatment regimens for chronic hepatitis C. Our data stress the positive impact of the ribavirin-induced TH2-TH1 cytokine shift at least in patients with normal ALT. Larger clinical studies with ribavirin priming seem warranted.
authors.affiliation: Department of Gastroenterology and Hepatology, Hospital of the University of Cologne, Cologne, Germany. ulrich.toex@uk-koeln.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Töx
authors.forename: Sigrid
authors.initials: S
authors.lastname: Schulte
authors.forename: Björn
authors.initials: B
authors.lastname: Heindl
authors.forename: Tobias
authors.initials: T
authors.lastname: Goeser
authors.forename: Uta
authors.initials: U
authors.lastname: Drebber
authors.forename: Annette
authors.initials: A
authors.lastname: Stelzer
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Steffen
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use*; D016207:Cytokines / Q000096:biosynthesis; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology
chemical_list: D000998:Antiviral Agents; D016207:Cytokines; D012254:Ribavirin; D000410:Alanine Transaminase