Peginterferon and ribavirin in HCV: Improvement of sustained viral response

Peginterferon alfa in combination with ribavirin is and will remain for the next years the current standard for treatment of chronic hepatitis C. The new antivirals currently investigated in phase II of III trials may augment the overall response rates but require peginterferon/ribavirin as backbone. The cure rate of peginterferon/ribavirin treatment can be improved by better education of treating physicians to identify and treat conditions which negatively influence the final outcome of therapy. Specific focus is the prevention and/or early treatment of common side effects of therapy including anaemia, cytopenia and depression. Measuring the viral response at various time points during treatment allows individualization of treatment duration. Based on these recent findings the treatment algorhytms for chronic hepatitis C will be reformulated (Figure 2 and Figure 3). The soon to be released German consensus statement for treatment of chronic hepatitis C will incorporate these recommendations.

1. Peginterferon/ribavirin is and will remain for the foreseeable future the standard of care for the treatment of chronic hepatitis C.

2. Sustained viral elimination (‘cure’) can be reached in about 50% of patients with genotypes 1 and 4, and in 70–80% of patients with genotypes 2 and 3. The major limitations for successful treatment in virologic responders are the well-known side effects of therapy. They may lead to decreased drug exposure or even early discontinuation of therapy.

3. Better education of treaters will improve side effect management and thus augment response rates.

4. Adaptation of treatment duration according to the rapidity of viral response is an important step for further improvement of outcome.

5. The impact of the new antiviral agents currently under investigation is unknown, but there is a great expectation that far more patients can be cured in future.

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Figure 2. Proposed treatment algorithm in patients infected with genotype 1 or 4. Shortening of treatment in patients with low baseline viral load is approved in Europe.

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Figure 3. Proposed treatment algorithm in patients infected with genotype 2 or 3. Shortening of treatment in patients with low baseline viral load is approved in Europe.

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Conflict of interest

Roche: member of the Global Advisory Board, of the speakers bureau and receives financial support for clinical studies. Vertex/Tibotec: Advisory board member, clinical investigator, Novartis/HGS: Advisory board member, clinical investigator.