TY - JOUR
T1 - A multicenter, randomized trial of daily high-dose interferon-alfa 2b for the treatment of chronic hepatitis C
T2 - Pretreatment stratification by viral burden and genotype
AU - Fried, Michael W.
AU - Shiffman, Mitchell
AU - Sterling, Richard K.
AU - Weinstein, Jeffrey
AU - Crippin, Jeffrey
AU - Garcia, Gabriel
AU - Wright, Teresa L.
AU - Conjeevaram, Hari
AU - Reddy, K. Rajender
AU - Peter, Joy
AU - Cotsonis, George A.
AU - Nolte, Frederick S.
N1 - Funding Information:
This study was supported in part by grants from Roche Molecular Systems and Schering-Oncology Biotech. The authors thank the following individuals for their invaluable assistance in the conduct of this study: Rivka Elbein, R.N., Robert Strauss, M.D., Norman Gitlin, M.D., Thomas Boyer, M.D., Dr. X. Li, Anthony Post, M.D., Dr. Karen Gutekunst, Dr. Betty Dragon, and Ms. Judi Buttala.
PY - 2000
Y1 - 2000
N2 - OBJECTIVES: The aim of this study was to determine prospectively whether an intensive regimen of daily, high-dose interferon would improve the response rate for the treatment of chronic hepatitis C in patients with unfavorable virological characteristics. METHODS: A total of 104 patients with chronic hepatitis C were randomized at eight centers to receive interferon alfa-2b at a dose of 5 million units (MU) daily or 3 MU t.i.w. for a period of 24 wk. Patients were prospectively randomized by low or high viral burden and stratified by genotype. HCV RNA was measured by quantitative polymerase chain reaction, and response rates were compared between the dosage regimens. RESULTS: HCV RNA levels dropped more rapidly to lower levels in the group treated with 5 MU daily. In this group, the initial virological response (IR) at wk 12 and the end-of-treatment response (ETR) at wk 24 were double that of patients treated with standard interferon (66% vs 33% and 48% vs 24%, p < 0.01). Sustained response rates were low for both dose groups (14% vs 4%, p = 0.08). Genotype-related differences in initial response rates were present in the standard dose group (63% non-1 genotype vs 24% genotype 1; p = 0.005) but not in those treated with 5 MU daily (66% vs 67%, p = NS). Using multivariate analysis, only the interferon dose was associated with IR and ETR (p = 0.002). CONCLUSIONS: Daily, high dose interferon rapidly dropped HCV RNA and increased initial and end-of-treatment response rates when compared to t.i.w, regimens. This effect, independent of viral burden and genotype, suggests that patients with unfavorable viral characteristics might benefit from an intensive regimen that promotes rapid viral clearance. These data support further study of the use of high-dose induction regimens. However, improvements in sustained response rates will require additional therapeutic maneuvers such as prolonged therapy or the adjunctive use of ribavirin. (C) 2000 by Am. Coll. of Gastroenterology.
AB - OBJECTIVES: The aim of this study was to determine prospectively whether an intensive regimen of daily, high-dose interferon would improve the response rate for the treatment of chronic hepatitis C in patients with unfavorable virological characteristics. METHODS: A total of 104 patients with chronic hepatitis C were randomized at eight centers to receive interferon alfa-2b at a dose of 5 million units (MU) daily or 3 MU t.i.w. for a period of 24 wk. Patients were prospectively randomized by low or high viral burden and stratified by genotype. HCV RNA was measured by quantitative polymerase chain reaction, and response rates were compared between the dosage regimens. RESULTS: HCV RNA levels dropped more rapidly to lower levels in the group treated with 5 MU daily. In this group, the initial virological response (IR) at wk 12 and the end-of-treatment response (ETR) at wk 24 were double that of patients treated with standard interferon (66% vs 33% and 48% vs 24%, p < 0.01). Sustained response rates were low for both dose groups (14% vs 4%, p = 0.08). Genotype-related differences in initial response rates were present in the standard dose group (63% non-1 genotype vs 24% genotype 1; p = 0.005) but not in those treated with 5 MU daily (66% vs 67%, p = NS). Using multivariate analysis, only the interferon dose was associated with IR and ETR (p = 0.002). CONCLUSIONS: Daily, high dose interferon rapidly dropped HCV RNA and increased initial and end-of-treatment response rates when compared to t.i.w, regimens. This effect, independent of viral burden and genotype, suggests that patients with unfavorable viral characteristics might benefit from an intensive regimen that promotes rapid viral clearance. These data support further study of the use of high-dose induction regimens. However, improvements in sustained response rates will require additional therapeutic maneuvers such as prolonged therapy or the adjunctive use of ribavirin. (C) 2000 by Am. Coll. of Gastroenterology.
UR - http://www.scopus.com/inward/record.url?scp=0033756124&partnerID=8YFLogxK
U2 - 10.1016/S0002-9270(00)02226-7
DO - 10.1016/S0002-9270(00)02226-7
M3 - Article
C2 - 11095346
AN - SCOPUS:0033756124
VL - 95
SP - 3225
EP - 3229
JO - The American Journal of Gastroenterology
JF - The American Journal of Gastroenterology
SN - 0002-9270
IS - 11
ER -