Firstline treatment for hepatitis C: combination interferon/ribavirin versus interferon monotherapy

In the initial treatment of chronic hepatitis C, interferon-alfa (IFN-alpha) monotherapy for 24-48 weeks induces sustained response rates of only 10-20%. Combination therapy with IFN-alpha plus ribavirin induces a sustained response in 40-50% of patients, and can be now recommended as the firstline therapy for chronic hepatitis C. Stopping therapy at week 12 because of persistent viraemia is unnecessary with the combination therapy because later clearance of HCV RNA can still occur with a sustained response. Patients with HCV genotype 1 should receive 48 weeks of combination therapy, in contrast to 24 weeks for patients with genotypes 2 or 3. For patients who cannot tolerate the side effects of ribavirin, such as anaemia, IFN-alpha at 3 MU three times weekly for 48 weeks is preferred as the initial therapy. The long-acting pegylated IFN can be expected to enhance the efficacy of combination therapy in the treatment of chronic hepatitis C and appears to be much more potent as monotherapy. Further studies are needed to improve the current 'half-full' status of chronic hepatitis C treatment.