Hepatitis C therapy in treatment-naïve patients

Until recently, interferon was the only approved therapy for previously untreated patients with chronic hepatitis C. Unfortunately, the majority of patients do not respond to this regimen, and rates of sustained virologic response were a disappointingly low 15% to 20%. Clearly, more effective treatment for this infection was needed. The nucleoside analogue ribavirin is now approved for administration in combination with interferon to treatment-naïve individuals with hepatitis C (HCV) infection as well as HCV-positive patients who have relapsed after interferon monotherapy. Results of a recent US multicenter trial in treatment-naïve patients with chronic hepatitis C demonstrate that combination therapy with interferon plus ribavirin produces sustained virologic response rates that are two to three times higher than those obtained with interferon alone. Rates of sustained virologic response (defined as undetectable serum HCV-RNA levels 24 weeks after completion of treatment) were 6% vs 31% after 24 weeks of interferon alone vs interferon plus ribavirin, respectively. For 48 weeks of treatment, rates of sustained virologic response were 13% and 38% with monotherapy and combination therapy, respectively. These results, which are consistent with those obtained in smaller preliminary trials and in a recently completed international multicenter trial, suggest that combination therapy with interferon and ribavirin may be preferable to monotherapy as first-line treatment for patients with chronic HCV infection.