Interferon-α plus ribavirin in chronic hepatitis C resistant to previous interferon-α course: results of a randomized multicenter trial

Background/Aims: Interferon-α plus ribavirin seem to be more efficacious than interferon monotherapy in chronic hepatitis C. In a multicenter randomized trial, we evaluated the efficacy of this association for interferon-α resistant chronic hepatitis C. Methods: Fifty patients who were non-responders to recombinant or lymphoblastoid interferon-α were randomized to receive either ribavirin (800 mg/day) plus leucocytic interferon-α (3 mega units thrice weekly) or the same dose of interferon-α alone, for 6 months. Effects of therapy were evaluated by serum aminotransferase and hepatitis C virus RNA levels and control liver biopsies. Results: At the end of treatment, aminotransferase levels become normal in 9/26 patients receiving combination therapy (35% [confidence interval, 16% to 53%]) and in 2/24 receiving interferon-α alone (8% [confidence interval, −3% to 19%]) (p=0.03). Aminotransferase normalization was never associated with hepatitis C virus RNA clearance. All patients with normal aminotransferase relapsed after discontinuation of therapy. At the end of treatment, mean hepatitis C virus RNA levels significantly decreased only in the group receiving combination therapy, but returned to pretreatment values 6 months thereafter. No histological improvement was observed in either group. Conclusions: There is no indication for treatment with interferon-α at the dose of 3 mega units thrice weekly plus 800 mg/day of ribavirin for 6 months in chronic hepatitis C resistant to interferon-α.