NEW YORK--Aggressive new interferon (IFN) treatment strategies aimed
at combating chronic hepatitis C virus (HCV) infection are roughly twice
as effective as the standard thrice-weekly, six-month IFN regimen.
"A 12-month to 18-month course of Intron A [IFN alfa-2b] nearly
doubles the sustained response among HCV patients," Robert G. Gish,
MD, said during a press briefing funded by an educational grant from Schering
Dr. Gish is medical director of the Liver Transplant Program at the
California Pacific Medical Center, San Francisco.
Left untreated, HCV infection can result in cirrhosis, and once cirrhosis
has begun, current treatment regimens are unlikely to clear the virus,
he said. However, recent data suggest that treating HCV-infected cirrhotic
patients with IFN may decrease their risk of developing liver cancer and
delay the time to death or transplantation. Thus, he suggests aggressive
IFN therapy for patients with early cirrhosis.
"Among cirrhotic patients with liver cancer, the five-year survival
rate is only about 5% to 20%," Dr. Gish said. However, patients with
this lethal disease combination have approximately an 80% survival rate
if liver transplant is performed. Unfortunately, many of these patients
are not candidates for transplant because their liver tumors exceed 10
Overall, he said, the management of HCV infection is promising given
IFN's proven efficacy and new combination treatments. Slow-release polyethylene
glycol (PEG)-bound IFN formulations under development may prove useful,
since they offer a convenient once- or twice-weekly dosing schedule.
Combination HCV Therapies Emerging
Ribavirin (Virazole), a guanine nucleoside analog approved in the US
Although the mechanism for the favorable synergistic effect is not yet
Approximately 40 US trials of the combination are underway in HCV patients
After six months of treatment, 52% of patients in both groups had no
Said Dr. Gish: "HCV therapy must be started early in the disease
process, be aggressive, and continue for the long-term. It is important
for all physicians to realize that this approach will improve survival,
and even cure the disease in many cases."