"Maintenance" treatment for patients with cirrhosis related to hepatitis C

Hepatitis C: current options for nonresponders to peginterferon and ribavirin

Hepatitis C virus infection remains a significant health problem worldwide. The development of interferon-based therapies has led to increased success in eradicating this viral infection; however, no recent additions to the current treatment care regimen (peginterferon and ribavirin) have been made. Nonresponders to peginterferon/ribavirin make up a diverse patient population that can be difficult to manage. Through a better understanding of treatment response and viral kinetics, clinicians are employing altered dosing schedules to minimize the burden of viral illness. Consequently, clinicians can now manage nonresponders by providing supportive care and reserving retreatment for those most likely to respond to additional antiviral therapy, particularly when correctable factors from a previous treatment course with the potential for positive intervention have been identified. The decision for further medical management is based on clinical and laboratory parameters that have been shown to predict which patients will benefit most from another attempt at therapy.

Systematic review of the treatment of established recurrent hepatitis C with pegylated interferon in combination with ribavirin

The aim of our study was to conduct a systematic review of studies evaluating antiviral therapy with pegylated interferon (PEG-IFN) alfa in combination with ribavirin for the management of recurrent hepatitis C after liver transplantation. Data sources included electronic databases and a manual search. Studies evaluating the efficacy and tolerability of PEG-IFN alfa with ribavirin in patients with recurrent hepatitis C were selected for inclusion. The information extracted from each of the selected publications included study design details, patient characteristics, treatment regimens and efficacy and tolerability end points. Nineteen studies including 611 patients were identified. PEG-IFN alfa-2b was used in 16 studies. The mean rate of SVR was 30.2% (range, 8-50%). Dose reduction and discontinuation of treatment were common in these studies (73% and 27.6%, respectively). The lack of an early virologic response (EVR) at 3 months of therapy was the most frequently described predictive factor of nonresponse. Treatment discontinuation and dose reductions due to adverse events were frequent and possibly represent important obstacles to attainment of SVR. EVR at 3 months of treatment should be considered an important predictor of treatment outcome.