Correspondence

Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis C

N Engl J Med 2003; 348:259-260January 16, 2003

Article

To the Editor:

Fried et al. (Sept. 26 issue)1 compared three treatment regimens in terms of sustained virologic response in patients with chronic hepatitis C virus (HCV) infection; the regimens were peginterferon alfa-2a plus ribavirin, interferon alfa-2b plus ribavirin, and peginterferon alfa-2a alone. Naturally, the patients receiving peginterferon alfa-2a plus ribavirin had the highest rate of sustained virologic response. In the community, the current treatment of choice is peginterferon alfa-2b with ribavirin. Thus, this study did not compare the newer regimen, peginterferon alfa-2a with ribavirin, with the best therapy currently available. The rate of sustained virologic response of 56 percent with peginterferon alfa-2a plus ribavirin is quite similar to the rates for peginterferon alfa-2b plus ribavirin in published reports. The media blitz by Hoffmann–LaRoche regarding the publication of this article in the Journal is much ado about nothing.

Neal E. Rakov, M.D.
89240 Overseas Hwy., Tavernier, FL 33070

1 References

1. 1

   Fried MW, Shiffman ML, Reddy KR, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002;347:975-982
   Full Text | Web of Science | Medline

Author/Editor Response

Dr. Rakov correctly notes that our study compared peginterferon alfa-2a and ribavirin with standard interferon alfa-2b and ribavirin. Thrice-weekly treatment with interferon alfa-2b and ribavirin, which was considered the standard of care when our study was initiated in 1999,1 represented the appropriate treatment for the control group. Peginterferon alfa-2a in combination with ribavirin recently received a unanimous recommendation for approval by an advisory panel to the Food and Drug Administration.

Our study demonstrated the superiority of peginterferon alfa-2a and ribavirin to standard therapy in terms of the overall sustained virologic response as well as for patients with characteristics associated with resistance to treatment, such as HCV genotype 1 and high levels of HCV RNA before treatment. These higher response rates were attained with a lower incidence of self-reported side effects, particularly influenza-like symptoms and depression. Furthermore, we demonstrated the predictability of a response to antiviral therapy by week 12 on the basis of changes in HCV RNA levels. These data provide extremely important information for the clinician who is treating patients with chronic hepatitis C. The study was not designed to compare peginterferon alfa-2a with combination regimens containing peginterferon alfa-2b.2 Physicians and other health care providers should be encouraged to review carefully all the available data from studies such as ours and determine which agent is best suited for their individual patients.

Michael W. Fried, M.D.
University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7038

2 References

1. 1

   McHutchison JG, Gordon SC, Schiff ER, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. N Engl J Med 1998;339:1485-1492
   Full Text | Web of Science | Medline

2. 2

   Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001;358:958-965
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   E. Santagostino, F. De Filippi, M. G. Rumi, M. Rivi, M. Colombo, P. M. Mannucci, . (2004) Sustained suppression of hepatitis C virus by high doses of interferon and ribavirin in adult hemophilic patients. Transfusion 44:5, 790-794
   CrossRef