Combination Treatment With Ribavirin and Interferon Alpha More Effective Than Treatment With Inferferon Alone
Treatment with ribavirin and interferon alpha is "significant[ly] beneficial" for all people infected with hepatitis C, regardless of previous treatment history, according to a study published in the Nov. 17 issue of the British Medical Journal. Lisa Kjaergard of the Center for Clinical Intervention Research in Denmark and colleagues performed a systematic review of 48 trials with 6,585 hepatitis C patients to determine the effectiveness of a combination treatment of interferon alpha and ribavirin compared to treatment solely with interferon alpha. The review included study patients who were followed either to the end of treatment or for 12 to 96 weeks after treatment. Patients coinfected with either hepatitis B or HIV were excluded, as were people with liver failure. Patients were classified into three groups: "naive," or those who had never been treated with interferon; "relapsers," or those who had responded to previous interferon therapy; and "non-responders," or those who had been treated with interferon but who had not responded to treatment.
Some of the review's findings appear below:
- Compared to interferon-only treatment, combination therapy reduced the risk by 28% of not having a virological response at the end of treatment for treatment-naive patients, while the risk for relapsers and non-responders was reduced by 47% and 17%, respectively.
- Six patients receiving combination therapy and 12 interferon-only patients developed cirrhosis, and there was a significant negative association between the benefit of combination therapy and the proportion of patients with cirrhosis.
- The benefits of combination therapy appeared to increase with the duration of treatment.
- The risk that patients would discontinue treatment was "significantly higher" among combination therapy patients.
- Liver-related morbidity and mortality from all causes showed a "non-significant" trend in favor of combination therapy.
- There was no significant association between the benefits of combination therapy and age and sex.
The researchers note that combination therapy had a more beneficial effect overall than treatment with interferon alone, but noted that none of the trials included in the study monitored patients long enough to determine whether it had an effect on liver-related morbidity and mortality. In addition, the negative association between cirrhosis and combination therapy suggests that patients with cirrhosis benefit less from the treatment. The researchers also question whether non-responders should receive combination treatment because only 15% of this group obtained a sustained virological response to treatment. They note that other modes of treatment, such as pegylated interferon with ribavirin, seem promising, but add that these methods need further study (Kjaergard et al., British Medical Journal, 11/17).