Ask the Experts - Re-treating the Patient Who Has Initially Failed...
Ask the Experts - Re-treating the Patient Who Has Initially Failed...
How would you recommend I treat a patient who responded to a 6-month course of interferon/ribavirin combination therapy and then relapsed 6 months after the end of treatment?
Aziz Kharchafi, MD
First, I am curious to know how you determined response. Was this enzyme response or loss of hepatitis C virus (HCV) RNA? Response should be determined by clearance of HCV RNA before discontinuing therapy.
Second, I would be interested in knowing the genotype of your patient's HCV. I assume it is genotype 1, the most common variant of HCV in US patients and the least likely to have a sustained response to combination interferon/ribavirin with just 6 months of therapy. Most clinicians would suggest that genotype 1 patients be treated for 12 months (assuming they have cleared HCV RNA at 6 months), and this suggests that you should reconsider therapy of your patient.
There have been a number of published studies of combination therapy in the re-treatment of patients who have failed treatment with interferon alfa alone. I have included some recent studies if you wish more information on the topic (see Suggested Reading). However, I am unaware of any published studies of re-treatment of patients who have initially failed treatment with interferon/ribavirin.
I believe that patients such as yours, who fail to sustain a response to a 6-month course of interferon/ribavirin therapy, should be considered for a repeat treatment course of 12 months of standard combination interferon alfa/ribavirin therapy. This is especially true for those with genotype 1 HCV. Another option would be to wait until combination pegylated interferon alfa/ribavirin becomes available for clinical use later this year. Early evidence indicates a higher response to treatment with combination pegylated interferon alfa/ribavirin than to treatment with standard interferon alfa/ribavirin.
How would you recommend I treat a patient who responded to a 6-month course of interferon/ribavirin combination therapy and then relapsed 6 months after the end of treatment?
Aziz Kharchafi, MD
First, I am curious to know how you determined response. Was this enzyme response or loss of hepatitis C virus (HCV) RNA? Response should be determined by clearance of HCV RNA before discontinuing therapy.
Second, I would be interested in knowing the genotype of your patient's HCV. I assume it is genotype 1, the most common variant of HCV in US patients and the least likely to have a sustained response to combination interferon/ribavirin with just 6 months of therapy. Most clinicians would suggest that genotype 1 patients be treated for 12 months (assuming they have cleared HCV RNA at 6 months), and this suggests that you should reconsider therapy of your patient.
There have been a number of published studies of combination therapy in the re-treatment of patients who have failed treatment with interferon alfa alone. I have included some recent studies if you wish more information on the topic (see Suggested Reading). However, I am unaware of any published studies of re-treatment of patients who have initially failed treatment with interferon/ribavirin.
I believe that patients such as yours, who fail to sustain a response to a 6-month course of interferon/ribavirin therapy, should be considered for a repeat treatment course of 12 months of standard combination interferon alfa/ribavirin therapy. This is especially true for those with genotype 1 HCV. Another option would be to wait until combination pegylated interferon alfa/ribavirin becomes available for clinical use later this year. Early evidence indicates a higher response to treatment with combination pegylated interferon alfa/ribavirin than to treatment with standard interferon alfa/ribavirin.
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