Interferon for interferon nonresponding and relapsing patients with chronic hepatitis C

Area of Science:

• Hepatology
• Virology
• Clinical Trials

Background:

• Interferon monotherapy achieves sustained virologic clearance in a small proportion of chronic hepatitis C patients.
• Conflicting evidence exists regarding the efficacy of retreatment with interferon for nonresponders and relapsers.

Purpose of the Study:

• To evaluate the benefits and harms of retreatment with interferon in chronic hepatitis C patients who previously failed interferon monotherapy (nonresponders and relapsers).

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) identified through comprehensive literature searches.
• Primary outcome: failure to achieve sustained virologic response (SVR) defined as undetectable hepatitis C virus RNA for at least six months post-treatment.
• Secondary outcomes: liver-related morbidity, mortality, biochemical responses, adverse events, and histology.

Main Results:

• Ten trials (686 nonresponders) and eight trials (484 relapsers) of poor methodological quality were included.
• In nonresponders, interferon improved biochemical response but virologic response data was limited. Longer treatment (48 vs. 24 weeks) reduced failure to achieve SVR.
• In relapsers, 48-week treatment was also superior to 24 weeks for SVR, but associated with more dose reductions. Higher interferon doses ( >3 MU thrice weekly) showed no added benefit for SVR in either group.

Conclusions:

• Interferon retreatment achieves SVR in a minority of chronic hepatitis C nonresponders and relapsers.
• Treatment durations of 48 weeks are more effective than 24 weeks for achieving SVR.
• Current data lacks information on the impact of interferon retreatment on clinical outcomes and histology.