DOCTOR'S VIEWS ARCHIVE

Topic: Hepatitis C, June 2000

Dr. Lee:
I have a viewer who underwent six months of treatment with interferon alone. After the treatment his hepatitis C RNA  test initially dropped and now is back at high levels again. What can we offer this patient who has developed disease relapse after treatment?

Dr. Edward Block:
Since he was initially treated with a single agent (interferon), he could be re-treated with combination treatment (interferon with ribavirin). We can hope for re-treatment success (long-term eradication of virus) rate of up to 30 to 40% with this combination.

Dr. Lee:
If we can achieve sustained eradication of virus for six months after completing treatment, are these patients considered cured forever?

Dr. Edward Block:
Well, we are a little reluctant to use the term "cured" at this time, since we have only a few years of data available.

But I believe that if one is disease-free (meaning that you have no detectable virus as measured by HCV RNA blood test) at six months following treatment completion, you are essentially cured.

We now have data that goes out 5 to 6 years. The recurrence rate of Hepatitis C in patients who are free of the virus at six months after treatment is extremely low (may be 1% or 2 %). So for the majority (more than 95%) of patients successfully treated, they can consider themselves essentially cured.

Dr. Lee:
Another viewer has undergone six months of combination therapy with interferon injections with ribavirin. This viewer also experienced a relapse several months after cessation of treatment. What would you do now?

Dr. Edward Block:
This is a more difficult patient to treat. If the patient had been treated with only six months of combination treatment and had a favorable response initially and then relapsed, then it would be reasonable to consider re-treating this patient for up to a year.

But if the patient has already received a year's worth of combination treatment then there is unlikely that re-treatment with the same combination for an additional year is going to do anything better for this patient.

We are actively looking for new treatments for these patients. At this time we don't have anything else commercially to offer.

We do sometimes offer these patients continuous use of interferon injections alone as a maintenance treatment. Even though one may not be able to completely eradicate the virus this way, there is evidence that people maintained on interferon alone may retard progression of liver damage. They may have delay of scarring or decrease of inflammation of the liver.

Dr. Lee:
Are there any new interferons or new combinations in the near or intermediate future?

Dr. Edward Block:
Well, the most exciting news is that we might see within the next six to twelve months the commercial release of a new interferon which is know as pegulated interferon. This interferon has the advantage of only needing to be taken one time weekly. It appears that this new interferon may actually be more effective than the older ones.

Dr. Lee:
Would this pegulated interferon be used in combination with ribavirin or used alone?

Dr. Edward Block:
It appears from the trials that this will need to be used in combination. Even though it may be a better interferon than what we have available, it is still alone not as good as the combination treatment.

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Last Editorial Review: 8/25/2000 7:54:00 AM