Retreatment of chronic hepatitis C with ribavirin followed by alpha interferon

Background: alpha interferon has proven of limited efficacy in the treatment of chronic hepatitis C. Ribavirin has also been used to treat chronic hepatitis C, but nearly all patients show relapse of hepatitis after the drug is discontinued. Therefore, new therapeutic strategies based on the use of both of these drugs are currently under evaluation. Methods: Patients, 16, with chronic hepatitis C resistant to a previous 6 months course of lymphoblastoid alpha-interferon (eight interferon non-responders and eight interferon relapsers) received a 4 month course of ribavirin, 1000 mg/day, followed by a second course of the same schedule of lymphoblastoid alpha-interferon, Results: During the course of ribavirin, alanine aminotransferase levels decreased in all patients (range 12.7-83.9%, median 61.80/o) and normalized in five earlier relapsers and in three earlier non-responders to alpha-interferon. In spite of the biochemical response to ribavirin, HCV-RNA remained detectable in the serum of all patients. lit the end of alpha-interferon treatment, transaminase levels were abnormal in all earlier non-responders and normal in five earlier relapsers to alpha-interferon. HCV-RNA was cleared from serum in three of them. Six months, after the complete course of ribavirin and alpha-interferon, sustained normalization of aminotransferase levels associated with persistent clearance of HCV-RNA. from serum was obtained in one of these patients. Another patient showed sustained biochemical response without clearance of HCV-RNA. In earlier relapsers to alpha-interferon, serum HCV-RNA levels decreased during treatment but returned to the pre-treatment values during the follow-up. The treatment could be carried out in all patients but one, who developed thrombocytopenia. Conclusions: This sequential treatment with ribavirin followed by alpha-interferon does not induce sustained response in previous non-responders to alpha-interferon alone and does not appear to significantly improve the results of retreatment with alpha-interferon alone in previous relapsers to treatment. (C) 1907 Elsevier Science B.V.