Authors' objectives:

The aim of this report is to evaluate antiviral treatment for chronic hepatitis C.

Authors' recommendations: With regard to antiviral therapy for chronic hepatitis C, the ICSI Technology Assessment Committee finds that: 1. Peginterferon-alfa2a/2b (PEG-IFN) and the combination of PEG-IFN and ribavirin are relatively safe when closely monitored by an experienced center. Serious side effects that may lead to discontinuation of treatment occur in 10% to 15% of patients and include neuropsychiatric effects (especially depression), influenza-like symptoms, and hematologic abnormalities such as anemia, neutropenia, and thrombocytopenia. 2. Hepatitis C virus (HCV) treatment with PEG-IFN plus ribavirin is presently the most efficacious treatment available for chronic HCV. (Conclusion Grade I) 3. For optimal treatment of HCV in genotype 1 patients, standard weekly dose PEG-IFN along with 1000-1200 mg/day ribavirin (depending on weight) given for a 48-week period leads to sustained virologic response (SVR) in about 40% to 50% of patients. 4. For optimal treatment of HCV in genotypes 2 and 3, standard weekly dose PEG-IFN along with 800 mg/day ribavirin for 24 weeks is adequate for 73% to 78% conversion to SVR status. Longer courses of treatment have not further improved outcomes in this subgroup. 5. Long-term follow-up of HCV cases with an SVR shows regression of fibrosis, a significantly decreased rate of cirrhosis development, and lower hepatocellular carcinoma (HCC) rates. However, the precise amount of risk reduction is unknown. (Conclusion Grade II) 6. Treatment non-responders (those who underwent previous treatment and did not achieve an SVR) show a low response rate on retreatment (15% to 20% SVR rate). Optimal selection criteria for treating non-responders are not known. 7. Predictors for a lower (worse) SVR rate include HCV genotype of 1, the presence of severe fibrosis or cirrhosis, advanced age, heavy alcohol use, obesity, and high viral load.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.icsi.org/knowledge/detail.asp?catID=107&itemID=263

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Institute for Clinical Systems Improvement

Contact Address: 8009 34th Avenue South, Suite 1200, Bloomington, MN, USA. Tel: +1 952 814 7060; Fax: +1 952 858 9675

Contact Name: icsi.info@icsi.org

Contact Email: icsi.info@icsi.org

Copyright: Institute for Clinical Systems Improvement (ICSI)