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. 2007 Jun;3(6 Suppl 20):4-32.

The practical management of treatment failure in chronic hepatitis C: a summary of current research and management options for refractory patients

Tarek Hassanein  1 , Mitchell L Shiffman, Nizar N Zein
Affiliations

The practical management of treatment failure in chronic hepatitis C: a summary of current research and management options for refractory patients

Tarek Hassanein et al. Gastroenterol Hepatol (N Y). 2007 Jun.
No abstract available

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Figures

Figure 1
Figure 1
Percentage of patients who achieve various virologie response patterns during treatment with peginterferon and ribavirin. SVR

sustained virologic response

HCV

hepatitis C virus.

Figure 2
Figure 2
Patterns of virologic response that can be observed during treatment with peginterferon and ribavirin. Adapted with permission from Shiffman. HCV

hepatitis C virus.

Figure 3
Figure 3
Sustained virologic response (SVR) based upon the time at which the patient first develops undetectable hepatitis C virus (HCV) RNA levels.
Figure 1
Figure 1
Effect of dose reduction on pegylated interferon (PEG-IFN) alfa-2a and ribavirin (RBV) response. The incidence of dose reductions among patients who cleared the virus at the end of treatment and after follow-up. Reprinted with permission from Aspinall and Pockros.
Figure 2
Figure 2
Sustained virologic response (SVR) rates in patients with chronic hepatitis C, according to adherence to both pegylated interferon alfa-2b and ribavirin. ≥80/≥80/≥80=adherent to ≥80% of IFN alfa-2b dose/adherent to ≥80% of ribavirin dose/adherent for ≥80% of prescribed treatment duration (48 weeks); <80/<80/>80, adherent to <80% of IFN alfa-2b dose/adherent to <80% of ribavirin dose/adherent for ≥80% of prescribed treatment duration; ITT=intent to treat. *P=.057 vs original intent-to-treat analysis; †P=.065 vs less adherent group; ‡P=.046 vs original ITT analysis; §P=.08 vs less adherent group. Reprinted with permission from Manns and created with data from Manns et al. and McHutchison et al.
Figure 3
Figure 3
Magnitude of hemoglobin decreases in patients treated with interferon alfa-2b and ribavirin. Adapted with permission from Sulkowski et al.
Figure 4
Figure 4
Time course of hemoglobin changes during treatment with interferon alfa-2b and ribavirin (RBV) in patients with chronic hepatitis C. Adapted with permission from Sulkowski et al.
Figure 5
Figure 5
Algorithm for the treatment of interferon-induced depression. BDI

Beck Depression Inventory

CES-D

Center for Epidemiological Studies Depression Rating Scale

SRI

serotonin reuptake inhibitor

Zung SDS

Zung Self-Rating Depression Scale Index score.

 Adapted with permission from Raison et al.
Figure 1
Figure 1
New treatment algorithm illustrating initial treatment for patients infected with hepatitis C virus (HCV) genotypes 1, 4, 6, or 7 and incorporating newer re-treatment strategies after treatment failure with pegylated interferon (PEG-IFN) and ribavirin (RBV). CIFN

consensus interferon.

See this image and copyright information in PMC

References

    1. Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet. 2001;358:958–965. - PubMed
    1. Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002;347:975–982. - PubMed
    1. Hadziyannis SJ, Sette H, Jr, Morgan TR, et al. Peginterferon-a2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med. 2004;140:346–355. - PubMed
    1. Shiffman ML, Suter F, Bacon BR, et al. A randomized controlled trial evaluating 16 and 24 weeks of peginterferon alfa-2a plus ribavirin in patients with HCV genotypes 2 or 3. N Engl J Med. In press.
    1. Shiffman ML, Pappas S, Nyberg S, et al. Peginterferon alfa-2A (PEGASYS) plus ribavirin (COPEGUS) for 16 or 24 weeks in patients with HCV genotype 2 or 3. Final results of the ACCELERATE trial. Presented at the European Association for the Study of Liver 41st Annual Meeting; April 26-30, 2006; Vienna, Austria. Abstract 734.

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