Chronic Hepatitis C More Responsive
to Peginterferon Than Interferon
WESTPORT, CT (Reuters Health) Dec 06 - For patients with
chronic hepatitis C with or without cirrhosis, a regimen of
peginterferon alpha-2a is significantly more effective than
treatment with interferon alpha-2a, according to two reports in
the New England Journal of Medicine for December 7.
During a 48-week trial, Dr. Stefan Zeuzem from the Klinikum
der Johann Wolfgang Goethe Universitat, Frankfurt, Germany,
and colleagues randomly assigned 267 patients with chronic
hepatitis C to receive 180 mcg of peginterferon alpha-2a once a
week for 48 weeks. They assigned 264 patients to receive 6
million units of interferon alpha-2a three times a week for 12
weeks, followed by 3 million units three times a week for 36
In an intention-to-treat analysis, Dr. Zeuzem's team found that at
48 weeks, 69% of the patients taking peginterferon had a high
rate of virologic response compared with 28% of the patients
taking interferon. Analysis at 72 weeks showed that a high
virologic response was present in 39% of the patients receiving
peginterferon and in 19% of those receiving interferon.
The investigators also report that "sustained normalization of
serum alanine aminotransferase concentrations at week 72 was
also more common in the peginterferon group than in the
interferon group (45% vs. 25%)."
In the second study, Dr. E. Jenny Heathcote, from Toronto
Western Hospital, Ontario, Canada, and colleagues randomized
271 patients with hepatitis C and cirrhosis or bridging fibrosis to
receive 3 million units of interferon alpha-2a three times a week
or 90 or 180 mcg of peginterferon alpha-2a once a week. Both
regimens lasted 48 weeks.
At 72 weeks, the investigators found that hepatitis C RNA was
undetectable in 30% of the patients who received 180 mcg of
peginterferon, compared with 15% of the patients who received
90 mcg of peginterferon, and 8% of the patients who were given
Serum alanine aminotransferase concentrations were normal at
72 weeks in 34% of the peginterferon 180 mcg group,
compared with 20% of the peginterferon 90 mcg group and 15%
of the interferon group.
In a subgroup of 184 patients for whom there were paired liver
biopsies, Dr. Heathcote and colleagues noted that at week 72
the rate of histologic response was 31% for those receiving 180
mcg of peginterferon, 44% for patients receiving 90 mcg of
peginterferon, and 54% for those receiving interferon.
In a related editorial, Dr. Daniel F. Schafer and Dr. Michael F.
Sorrell from the University of Nebraska Medical Center,
Omaha, say that although peginterferon alpha-2a is not yet
approved for use in the US, "treatment with peginterferon
alpha-2a in combination with ribavirin is the next obvious step in
the treatment of chronic hepatitis C virus infection."
N Engl Med 2000;343:1666-1680,1723-1724.