I read thru this and saved it. While it is primarily about retreatment, read
thru and notice when I broke it out - that if you were undetectable at 20
weeks, reducing ribavarin after that had no effect on eventual outcome.
Seems you could drop back on the ribavarin which may help the anemia and not
Peginterferon Alfa-2a and ribavirin in patients with chronic
hepatitis C who have failed prior treatment.
Shiffman ML, Di Bisceglie AM, Lindsay KL, Morishima C, Wright EC,
Everson GT, Lok AS, Morgan TR, Bonkovsky HL, Lee WM, Dienstag JL,
Ghany MG, Goodman ZD, Everhart JE.
Background & Aims: The most effective therapy currently available for
treatment of chronic hepatitis C virus (HCV) is the combination of
peginterferon and ribavirin. This study evaluated the effectiveness
of this treatment in patients who were nonresponders to previous
interferon-based therapy. Methods: The first 604 patients enrolled in
the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis
(HALT-C) Trial were evaluated. All were HCV RNA positive, previous
nonresponders to interferon, with or without ribavirin, and had
bridging fibrosis or cirrhosis on liver biopsy (Ishak fibrosis stage
3-6). Patients were retreated with peginterferon alfa-2a 180
microg/wk plus ribavirin 1000-1200 mg/day. Those with no detectable
HCV RNA in serum at week 20 continued treatment for a total of 48
weeks and were then followed for an additional 24 weeks.Results:
Thirty-five percent of patients had no detectable HCV RNA in serum at
treatment week 20, and 18% achieved sustained virologic response
(SVR). Factors associated with an SVR included previous treatment
with interferon monotherapy, infection with genotypes 2 or 3, a lower
AST:ALT ratio, and absence of cirrhosis.
******* Reducing the dose of
ribavirin from >/=80% to </=60% of the starting dose during the first
20 weeks of treatment was associated with a decline in SVR from 21%
to 11% (P </= 0.05). In contrast, reducing the dose of peginterferon
or reducing ribavirin after week 20, when HCV RNA was already
undetectable, did not significantly affect SVR.********
nonresponders to previous interferon-based therapy can achieve SVR
following retreatment with peginterferon alfa-2a and ribavirin.
PMID: 15057741 [PubMed - in process]