Hepatitis C is a major cause of illness and death worldwide, affecting around 300 million people annually.
The current standard initial therapy for patients with chronic hepatitis C is interferon alfa-2b in combination with another drug called ribavirin. This association has been found to be effective in treating the disease in around 40% of patients.
Michael Manns and colleagues from Hannover Medical University, Germany, assessed whether peginterferon alfa-2b plus ribavirin could be more effective than interferon alfa-2b plus ribavirin.
A total of 1530 chronic hepatitis C patients, from Europe, Argentina, USA, and Canada, were assigned one of three treatments.
The first regimen option was interferon alfa-2b (3 MU subcutaneously, 3 times per week) plus oral ribavirin 1000-1200 mg/day. The second was peginterferon alfa-2b (1.5 µg/kg each week) plus 800 mg/day ribavirin. The third treatment option was peginterferon alfa-2b (1.5 µg/kg per week, for 4 weeks, then 0.5 µg/kg per week) plus ribavirin 1000-1200 mg/day for 48 weeks.
The primary endpoint was the proportion of patients with a sustained viral response (SVR; undetectable hepatitis C virus [HCV] RNA in blood) at 24-week follow-up.
Peginterferon alfa-2b plus ribavirin will replace current standard therapy for chronic HCV.
| Michael Manns |
The SVR rate was greater in the higher-dose peginterferon group (274 out of 511, 54%) than in the lower-dose peginterferon (244 out of 514, 47%) or interferon (235 out of 505, 47%) groups.
Among patients with the more serious HCV genotype-1 infection, the corresponding SVR rates were 42% (145/348), 34% (118/349), and 33% (114/343).
The rate for patients with genotype-2 and 3 infections was about 80% for all treatment groups.
Michael Manns comments, "The most effective therapy for the initial treatment of suitable patients with chronic hepatitis C, according to this study, is the combination of 1.5 µg/kg per week of peginterferon alfa-2b with ribavirin."
He adds, "Because of the improved response rate and more convenient once-weekly administration schedule, this regimen will replace the current standard of interferon alfa-2b plus ribavirin."