New schedules of interferon for chronic hepatitis C

Current treatment regimens with either long-term interferon monotherapy or interferon-ribavirin combination achieve sustained response rates of 40–50%. Options to improve the sustained response to interferon include longer treatment duration, higher fixed doses throughout the course of therapy, de-escalating strategies in which more intensive treatment is given during the initial weeks of treatment (so-called induction dosing) or escalation strategies in which the dose is progressively increased until a response occurs. Published literature supports the use of a treatment period of at least 12 months. Although higher doses which are fixed throughout the treatment course result in a moderate increase in sustained response rate, this may not be justified by the cost and added side effects. Athough high dose induction strategies may result in a more rapid decline in serum HCV RNA levels, it is not yet known whether this will result in better long-term outcome. Preliminary evidence suggests that the benefit may be confined to subgroups of patients who might be predicted to have a poor response to standard therapy, such as those with high pre-treatment viral levels.