Authors' objectives:

To provide guidance on the use of interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of chronic hepatitis C.

Authors' recommendations: Guidance 1.1 Combination therapy with peginterferon alfa and ribavirin is recommended within its licensed indications for the treatment of people aged 18 years and over with moderate to severe chronic hepatitis C (CHC), defined as histological evidence of significant scarring (fibrosis) and/or significant necrotic inflammation. 1.2 People with moderate to severe CHC are suitable for treatment if they have: - not previously been treated with interferon alfa or peginterferon alfa, or - been treated previously with interferon alfa (as monotherapy or in combination therapy), and/or - previously received peginterferon alfa monotherapy only and responded at the end of treatment but subsequently relapsed, or did not respond at the end of treatment. 1.3 People currently being treated with interferon alfa, either as combination therapy or monotherapy, may be switched to the corresponding therapy with peginterferon alfa. 1.4 Treatment for the groups identified in Sections 1.1 and 1.2 should be as follows. - People infected with hepatitis C virus (HCV) of genotype 2 and/or 3 should be treated for 24 weeks. - For people infected with HCV of genotype 1, 4, 5 or 6, initial treatment should be for 12 weeks. Only people showing, at 12 weeks, a reduction in viral load to less than 1% of its level at the start of treatment (at least a 2-log reduction, see Section 4.1.2.5) should continue treatment until 48 weeks. For people in whom viral load at 12 weeks exceeds 1% of its level at the start of treatment, treatment should be discontinued. - People infected with more than one genotype that includes one or more of genotypes 1, 4, 5, or 6 should be treated as for genotype 1. 1.5 People satisfying the conditions in Sections 1.1 and 1.2 but for whom ribavirin is contraindicated or is not tolerated should be treated with peginterferon alfa monotherapy. Regardless of genotype, individuals should be tested for viral load at 12 weeks, and if the viral load has reduced to less than 1% of its level at the start of treatment, treatment should be continued for a total of 48 weeks. If viral load has not fallen to this extent, treatment should stop at 12 weeks. 1.6 People for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic HCV infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. 1.7 There is insufficient evidence to recommend combination therapy using peginterferon alfa or interferon alfa in people who: - have previously been treated with combination therapy using peginterferon alfa, and/or - are younger than 18 years of age, and/or - have had a liver transplantation. Treatment of CHC recurrence after liver transplantation (whether or not the person had been treated with interferon alfa or peginterferon alfa therapy at any time before transplantation) should be considered as experimental and carried out only in the context of a clinical trial.

Authors' methods: Systematic review

Project Status: Completed

Year Published: 2004

URL for published report: http://publications.nice.org.uk/interferon-alfa-pegylated-and-non-pegylated-and-ribavirin-for-the-treatment-of-chronic-hepatitis-ta75

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: <p>National Institute for Clinical Excellence (NICE)</p>