New schedules of interferon for chronic hepatitis C

Current treatment regimens with either long-term interferon monotherapy or interferon-ribavirin combination achieve sustained response rates of 40-50%. Options to improve the sustained response to interferon include longer treatment duration, higher fixed doses throughout the course of therapy, de-escalating strategies in which more intensive treatment is given during the initial weeks of treatment (so-called induction dosing) or escalation strategies in which the dose is progressively increased until a response occurs. Published literature supports the use of a treatment period of at least 12 months. Although higher doses which are fixed throughout the treatment course result in a moderate increase in sustained response rate, this may not be justified by the cost and added side effects. Although high dose induction strategies may result in a more rapid decline in serum HCV RNA levels, it is not yet known whether this will result in better longterm outcome. Preliminary evidence suggests that the benefit may be confined to subgroups of patients who might be predicted to have a poor response to standard therapy, such as those with high pre-treatment viral levels.