A team from Denmark assessed the efficacy and safety of interferon alfa with or without ribavirin for treatment of chronic hepatitis C.
The researchers conducted a systematic review of randomized trials on interferon alfa plus ribavirin combination therapy versus interferon alfa alone.
Patients were either naive (not previously treated with interferon), relapsers (transient response to previous interferon therapy), or non-responders (no response to previous interferon therapy).
Of 1155 references identified, 48 trials with 6585 patients met the inclusion criteria.
Patients were followed to the end of treatment in 20 trials, and for 12-96 weeks after treatment in 28 trials.
Compared with interferon, combination therapy was found to reduce the risk of not having a sustained virological response for 6 months by 26% in naive patients. The risk was reduced by 33% in relapsers and 11% in non-responders.
Morbidity and mortality showed a non-significant trend in favor of combination therapy (Peto odds ratio, 0.45).
| Interferon alfa plus ribavirin improved both virological and histological responses.
| British Medical Journal |
Combination therapy significantly reduced the risk of not having improvement in results of histology by 17% in naive patients, and by 27% in relapsers and non-responders.
The researchers found that the risk of treatment discontinuations was significantly higher after combination therapy (relative risk, 1.28).
Author Lise L. Kjaergard, of the Center for Clinical Intervention Research, Rigshospitalet, Copenhagen, concluded on behalf of the group, "Treatment with interferon alfa plus ribavirin has a significant beneficial effect on the virological and histological responses of patients with chronic hepatitis C, irrespective of previous treatment.
"Combination therapy may therefore also be considered appropriate for relapsers and non-responders."