Adherence to therapy and sustained virological response in patients with chronic hepatitis C treated with standard interferon (IFN) plus ribavirin (RBV)

Introduction: Just prior to the era of pegylated IFNs, long-term treatment with a combination of standard IFN-alfa2 plus RBV was regarded as the best antiviral treatment for chronic hepatitis C (CHC). Adherence to this lengthy and troublesome therapy is a major challenge for both the pts and their doctors. Aim: To survey our experience with this treatment modality.

Patients and methods: Since 1997, 88 CHC pts were treated over 48 weeks with 3–6 MU IFN-α2 three times a week, combined with 1.0–1.2g RBV daily. Fifty-seven (65%) had not participated in previous IFN treatment, 17 (19%) were non-responders to IFN and 14 (16%) had relapsed following previous IFN monotherapy.

Results: Seven pts (7.9%) were forced to abandon treatment because of side-effects. Overall 24 pts (27.3%) displayed a sustained virological response (SVR). This success was achieved by 22 (38.6%) of the 57 IFN-naive, but only 2 (6.4%) of the 31 not IFN-naive pts. Sixty-two (70.5%) of the 88 pts fulfilled the criteria of good (at least 80/80/80%) adherence to the therapy, and 21 of these (33.9%) gave a SVR; the correlation between adherence and SVR was statistically significant (P<0.05). Twenty-six (29.5%) of the 88 pts did not achieve this level of adherence, mostly because side-effects requiring dose reductions; 4 of them were IFN-related, 18 were RBV-related, and 2 were related to both IFN and RBV. A thyroid dysfunction developed during 15.9% of the treatments; nevertheless, it did not significantly influence either the adherence or the outcome.

Conclusions: With this combined treatment modality, a virological cure can be achieved in about 39% of IFN-naive CHC pts. Adherence to therapy proved to be an important factor in achieving a SVR.