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Retreatment of Non-Responders

October 19, 2004

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According to this article, retreatment is not a very viable strategy in most cases of a failed first attempt to eradicate the virus with interferon therapy. This repeat approach only seems somewhat successful with people who were not treated with combination therapy to begin with.

It seems only some of those who received monotherapy (before the combo was developed) really have any chance of success with this subsequent combo treatment. And, only if they are not genotype 1, have a low viral load, do not have cirrhosis.

Reading between the lines here also reinforces our belief that the success rates being tossed about by doctors are misleading. This article states that nearly half do not respond. If this includes all genotypes then the higher rate for genotype 2 (supposedly around 80%) is clearly being reduced by the lower rate for genotype 1 (supposedly around 50% but more likely less than 30% to arrive at the “nearly half” statement). With 70% of the US chronic Hepatitis C having genotype 1, this is significant.

Retreatment of Non-Responders

Despite improvements in the treatment of chronic hepatitis C virus (HCV) infection, nearly half of all patients do not respond to initial therapy.

Retreatment of these patients with pegylated interferon and ribavirin has been successful in only a limited percentage of cases.

Factors associated with sustained virologic response (SVR) following retreatment include prior treatment with interferon monotherapy, HCV genotype 2 or 3, a low serum HCV RNA level, and the absence of cirrhosis.

Fewer than 6% of nonresponders who were previously treated with interferon and ribavirin and who have cirrhosis, genotype 1, and a high viral load achieve SVR following retreatment with pegylated interferon and ribavirin.

No therapy has been shown to yield SVR in patients who do not respond to pegylated interferon and ribavirin.

Long-term maintenance therapy with pegylated interferon is currently being evaluated in nonresponders with advanced fibrosis and cirrhosis. Its use should be considered investigational at this time.

Hepatology Section, Virginia Commonwealth University Medical Center, Richmond, VA.

10/18/04

Reference
M L Shiffman. Retreatment of patients who do not respond to initial therapy for chronic hepatitis C. Cleveland Clinical Journal of Medicine 71 (Suppl 3): S13-16. May 2004.

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