Interferon and ribavirin are two drugs licensed for the treatment of persons with chronic hepatitis C.
Interferon and lamivudine are two drugs licensed for the treatment of persons with chronic hepatitis B.
Alpha interferon can be taken alone, or in combination with ribavirin, for treatment of hepatitis C. Combination therapy is currently the treatment of choice.
Effectiveness is measured by the sustained response rate (no virus following 6 months of treatment) and only occurs with combination therapy in about four out of 10 patients.
New forms of interferon that have been developed may increase the likelihood of viral reduction and even when interferon fails to reduce the viral load, there is evidence that it reduces liver inflammation and may protect against liver cancer.
A new interferon compound (pegylated interferon) injected once weekly has been shown to maintain sustained response rates similar to the combination of alpha interferon and ribavirin.
In Europe, the combination of pegylated interferon and ribavirin is now the standard of care.
Interferon increases the immune response and reduces viral replication.
Only 10 to 20 percent of patients with chronic hepatitis C have a sustained response to standard interferon therapy (up to 12 months with 3 injections a week). Although longer duration (18 to 24 months) of treatment, higher doses, and treatment with other types of interferon may improve the response, many patients still relapse. Furthermore, these approaches tend to be poorly tolerated.
Combination therapy (interferon plus ribavirin):
Initial therapy with interferon and ribavirin is more effective than treatment with interferon alone. Some findings indicate that the combination therapy doubles the response in eliminating the virus (to 30-38%).
Recent studies show that when pegylated interferon was used with ribavirin, the response rate increased 8 percent (to 38-46%). Ribavirin when used alone is not able to eradicate the hepatitis C virus and needs to be used together with interferon.
Discontinuation of therapy:
Discontinuation of therapy for an adverse event has been reported in some studies to be more frequent with combination therapy (19%) and monotherapy (13%) given for 48 weeks than combination therapy given for 24 weeks (8%).
Either interferon or lamivudine can be taken alone, or in combination, for hepatitis B.
Effectiveness of the solo interferon and lamivudine therapies -- measured by undetectible virus and development of antibodies to the hepatitis B antigen -- is rather similar, with success seen in only approximately two out of 10 patients.
Preliminary studies suggest that a combination of the two drugs might be effective for as many as one patient in three.
What You Need to Know Before Treatment
Before any treatment for hepatitis B or C begins, the patient needs to:
- Be fully aware of the likelihood of achieving a sustained response.
- Know the potential duration of therapy.
- Know of treatment side effects.
- Understand the importance of practicing"safer sex."
- Comply with regular monitoring of blood tests and quality of life issues throughout treatment.
- Have a positive attitude.
- Avoid fear by increasing education.
- Have support from family or loved ones.
- Not focus on response rates alone.
The timing of the any interferon treatment should be tailored to the patients other activities, because once treatment is started, it requires considerable commitment both on the part of the patient, the patient's family, and the attending health care personnel.