The Pharmaceutical Journal Vol 267 No 7175 p733-738
24 November 2001

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Interferon alfa beneficial in hepatitis C

Treatment of acute hepatitis C with interferon alfa-2b prevents chronic infection, say researchers, but the trial has been criticised because a third of patients may recover anyway without treatment.

Elmar Jaeckel from Hanover Medical School, Germany, and colleagues identified 44 patients with acute hepatitis C and treated them with interferon alfa-2b (Intron A) for 24 weeks. Virological response was monitored before, during and 24 weeks after therapy. The investigators found that 98 per cent of the patients had undetectable levels of hepatitis C virus RNA and normal serum alanine aminotransferase levels at the end of treatment and follow-up. They add that without treatment only about 30 per cent of patients would have recovered (New England Journal of Medicine 2001;345:1452).

In an accompanying editorial, Jay Hoofnagle of the National Institute of Diabetes and Digestive and Kidney Diseases, United States, says that the study had limitations. If the patients studied remained untreated, perhaps fewer than 50 per cent might have become chronically infected. If all patients were treated it would mean giving an expensive, difficult to tolerate drug to patients who might recover without it (ibid p1495).

In a separate study Lise Kjaergard from the Centre for Clinical Intervention Research, Copenhagen, Denmark, and colleagues reviewed randomised trials of interferon alfa with or without ribavirin for treating chronic hepatitis C. Forty-eight trials involving 6,585 patients were included. Patients were either naive (not previously treated with interferon), relapsers (transient response to previous interferon therapy) or non-responders (no response to previous interferon therapy). Compared with interferon alone, combination therapy reduced the risk of not having a sustained virological response for 6 months by 26 per cent in naive patients (relative risk 0.74, 95 per cent confidence interval 0.70 to 0.78), 33 per cent in relapsers (0.67, CI 0.57 to 0.78) and 11 per cent in non-responders (0.89, CI 0.83 to 0.96). Morbidity and mortality showed a non-significant trend in favour of combination therapy. The reviewers acknowledged that combination therapy also significantly increased the number of adverse events. They concluded that combination therapy may also be considered appropriate for relapsers and non-responders (BMJ 2001;323:1151).

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