Treatment of chronic hepatitis C with a combination of alpha-2a peginterferon with ribavirin
Viral hepatitis C - the problem is associated with the lack of specific immunoprophylaxis of this infection, with the high incidence of chronic forms leading to the development of cirrhosis of the liver and hepatocellular carcinoma.
Viral hepatitis C is an increasingly urgent medical problem, which is associated with the lack of specific immunoprophylaxis for this infection, with the high incidence of chronic forms leading to the development of cirrhosis and hepatocellular carcinoma.
Combination therapy with alpha-interferon and ribavirin has been shown to be more effective than monotherapy with alpha-interferon in patients with chronic viral hepatitis C (HCG). Such therapy is currently recognized as standard in the treatment of HCV.
Pegylated interferons alpha-2a and alpha-2b, which differ in chemical structure and pharmacokinetic parameters, have shown significantly higher efficacy than interferon-2a as monotherapy with chronic hepatitis C in a number of clinical trials controlled. However, it is still unclear whether combination therapy with peginterferons and ribavirin would outweigh the effectiveness of monotherapy with these drugs in patients with chronic hepatitis C.
To this end, the international study group Pegasys conducted an international multicentre randomized comparative study of the efficacy and safety of three modes of initial treatment for chronic hepatitis C: alpha-2a peginterferon + ribavirin, alpha- 2b interferon + ribavirin and alpha-2a peginterferon as monotherapy. The results of the study were published in the New England Journal of Medicine of September 26, 2002.
Patients participating in the study (N = 1,121) were randomized into three treatment groups: 1) 180 μg of alpha-2a peginterferon once a week + ribavirin (1 or 1.2 g depending on body weight) by day; 2) peginterferon alpha-2a at the same dose once a week + placebo; 3) Interferon alpha-2b 3 million units 3 times a week + ribavirin 1 time a day. The duration of the study treatment was 48 weeks.
A more stable virologic response was observed in the group of patients receiving a combination of alpha-2a peginterferon with ribavirin, compared to patients receiving a combination of alpha-2a interferon with ribavirin (56% vs 44%, p less than 0.001) or monotherapy with peginterferon alpha-2a (56% vs 29%, p less than 0.001). The frequency of persistent virologic response in patients with genotype 1 hepatitis C virus was 46%, 36% and 21%, respectively, of the three regimens. In the subgroup of patients with a high initial RNA level of this virus, this indicator was 41%, 33% and 13% respectively.
The safety profile of the three regimens was identical. Adverse reactions such as flu-like illness and depression were less common in the alpha-2a peginterferon treatment groups than in the alpha-2a treatment group with interferon and ribavirin.
According to the results of the study, the authors concluded that combination therapy with alpha-2a peginterferon with ribavirin has similar tolerance but higher efficacy (as measured by the frequency of virological response) compared to monotherapy with alpha-2a peginterferon and with a combination of interferon alpha-2b with ribavirin in the treatment of patients with chronic hepatitis C.