Results of a randomised trial in this week's issue of THE LANCET suggest that the drug combination peginterferon alfa-2b and ribavirin offers the best therapeutic treatment for patients with chronic hepatitis C.
Hepatitis C is a major cause of illness and death worldwide, affecting around 300 million people annually. The current standard initial therapy for patients with chronic hepatitis C is interferon alfa-2b in combination with ribavirin; this has been shown to be effective in around 40% of patients with chronic disease. Michael Manns and colleagues from Hannover Medical University, Germany, assessed whether peginterferon alfa-2b plus ribavirin could be more effective than interferon alfa-2b plus ribavirin.
1530 patients from Europe, Argentina, USA, and Canada with chronic hepatitis C were assigned one of three treatments: interferon alfa-2b (3 MU subcutaneously three times per week) plus oral ribavirin 1000-1200 mg/day; peginterferon alfa-2b 1.5 µg/kg each week plus 800 mg/day ribavirin; or peginterferon alfa-2b 1.5 µg/kg per week for 4 weeks then 0.5 µg/kg per week plus ribavirin 1000-1200 mg/day for 48 weeks. The primary endpoint was the proportion of patients with a sustained viral response (SVR; undetectable hepatitis C virus [HCV] RNA in blood) at 24-week follow-up.
The SVR rate was higher in the higher-dose peginterferon group (274/511 [54%]) than in the lower-dose peginterferon (244/514 [47%]) or interferon (235/505 [47%]) groups. Among patients with the more serious HCV genotype 1 infection, the corresponding SVR rates were 42% (145/348), 34% (118/349), and 33% (114/343). The rate for patients with genotype 2 and 3 infections was about 80% for all treatment groups.
Michael Manns comments: "The most effective therapy for the initial treatment of suitable patients with chronic hepatitis C according to this study is the combination of 1.5 µg/kg per week of peginterferon alfa-2b with ribavirin. Because of the improved response rate and more convenient once-weekly administration schedule, this regimen will replace the current standard of interferon alfa-2b plus ribavirin."
Contact: Professor Michael P Manns, Department of Gastroenterology and Hepatology, Medical University Hannover; T) (mobile) 49-511-831-3834 or 49-511-532-3305 ;F) 49-511-532-4896; E) manns.michael@mh-hannover.de
The Lancet