Ribavirin: Current role in the optimal clinical management of chronic hepatitis C

被引:56
作者
Reddy, K. Rajender [1 ]
Nelson, David R. [2 ]
Zeuzem, Stefan [3 ]
机构
[1] Univ Penn, GI Div, Philadelphia, PA 19104 USA
[2] Univ Florida, Coll Med, Div Gastroenterol Hepatol & Nutr, Gainesville, FL USA
[3] Univ Frankfurt Hosp, Dept Med 1, Frankfurt, Germany
关键词
Ribavirin; Chronic hepatitis C; Sustained virological response; INTERFERON-ALPHA-2B PLUS RIBAVIRIN; PEGINTERFERON ALPHA-2B; PEGYLATED INTERFERON; ANTIVIRAL ACTIVITY; VIRUS-INFECTION; GENOTYPE-1; PATIENTS; RANDOMIZED-TRIAL; EPOETIN-ALPHA; COMBINATION THERAPY; NUCLEOSIDE ANALOG;
D O I
10.1016/j.jhep.2008.11.006
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Ribavirin in combination with peginterferon alfa shows strong clinical efficacy against chronic hepatitis C, and is now established as the standard of care. However, the precise role of ribavirin is still being defined, suggesting that optimal ribavirin dose should be maintained over the whole treatment period. Ribavirin dosage varies by bodyweight for genotype I disease (1000 mg/day in patients <= 75 kg and 1200 mg/day in patients > 75 kg), whereas 800 mg/day is sufficient to ensure optimal response in all genotype 2/3 patients. Similarly, genotype 1 patients benefit from 48 weeks of therapy, while 24 weeks is sufficient for genotype 2/3 disease. Recent data suggest treatment success is dependent on cumulative ribavirin exposure, as patients who receive < 60%, of the planned dose have lower response rates, regardless of whether reductions are from temporary interruptions or premature cessation of therapy. All patients should be monitored for hemolytic anemia, as early diagnosis allows management through small dose reductions and stepwise return to the target dose, maximizing cumulative exposure. Despite these recent advances in our knowledge, many questions remain, such as whether the role of ribavirin will change or even be eliminated as new therapies are developed. (C) 2008 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:402 / 411
页数:10
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