Pegylated interferon alfa should be used in hep C
Combination therapy with peginterferon alfa and ribavirin should be used to treat adults with moderate to severe chronic hepatitis C, says the National Institute for Clinical Excellence in guidance issued this week. Patients who are aged 18 years or over are considered suitable
for treatment if:
• They have not been treated with peginterferon alfa or standard interferon
previously or
• They have previously been treated with interferon alfa but not peginterferon
alfa or
• They have been treated with peginterferon alfa monotherapy, but treatment
failed
The length of treatment depends on the genotype of the hepatitis C virus
and the patient’s initial response to therapy.
The new guidance replaces recommendations made by NICE in October 2000,
which endorsed the use of standard interferon alfa plus ribavirin to
treat moderate to severe chronic hepatitis C. Since then, pegylated interferon
alfa has been shown to yield higher sustained viral response rates than
standard interferon alfa in randomised clinical trials. In addition,
the polyethylene glycol (PEG) molecule attached to the interferon, increases
the drug’s half life, allowing once-weekly injections rather than
the three injections each week that are needed with standard interferon.
Side effects, such as influenza-like symptoms, which can lead to non-compliance
with therapy, are also reduced.
The cost of 24 weeks’ treatment with peginterferon alfa plus ribavirin
has been estimated at £6,000, excluding monitoring costs. This
is an increase of about £2,000 on the estimated cost of combination
therapy with standard interferon and ribavirin. However, NICE says this
increase is cost effective and that patients who are currently being
treated with standard interferon alfa may be switched to peginterferon.
The full guidance is available via the NICE website. |
The
Pharmaceutical Journal