Gambarin-Gelwan M, Jacobson I M
Weill Cornell Medical College, New York, NY 10021, USA.
J Viral Hepat. 2008 Sep;15(9):623-33. doi: 10.1111/j.1365-2893.2008.01018.x. Epub 2008 Jul 10.
Chronic hepatitis C affects 170 million people worldwide, including up to 4 million people in the United States. The current standard of care therapy with pegylated interferon (PEG-IFN) and ribavirin (RBV) while highly successful in patients with genotype 2 and 3 infection, allows for sustained virologic response in 42-46% of treatment-naïve genotype 1 patients, comprising about 70% of cases of chronic hepatitis C in the USA. While awaiting approval of Specifically Targeted Antiviral Therapy for HCV (STAT-C) agents, which will require the completion of additional clinical trials, it is important to optimize the dose and duration of currently available treatment modalities, namely PEG-IFN and RBV, for treatment of CHC. Results of several recent trials evaluating optimal dosing of RBV and higher than standard dosing of PEG-IFN in treatment-naïve genotype 1 patients, as well as data from retreatment trials with "induction" doses of PEG-IFN or high-dose RBV in prior non-responders to IFN-based therapy will be reviewed here. The possibility of shorter duration of therapy for genotype 2 and 3 patients based on recent publications and presentations will be discussed as well.
慢性丙型肝炎在全球影响着1.7亿人，其中包括美国多达400万人。目前采用聚乙二醇干扰素（PEG - IFN）和利巴韦林（RBV）的标准治疗方案，虽然在2型和3型感染患者中非常成功，但在初治的1型患者中，只有42% - 46%能实现持续病毒学应答，而1型患者约占美国慢性丙型肝炎病例的70%。在等待丙型肝炎特异性靶向抗病毒治疗（STAT - C）药物获批（这需要完成更多临床试验）的同时，优化目前可用治疗方式（即PEG - IFN和RBV）治疗慢性丙型肝炎的剂量和疗程非常重要。本文将回顾近期几项评估初治1型患者中利巴韦林最佳剂量和高于标准剂量的聚乙二醇干扰素的试验结果，以及既往基于干扰素治疗无应答者采用“诱导”剂量聚乙二醇干扰素或高剂量利巴韦林进行再治疗试验的数据。还将根据近期的出版物和报告讨论2型和3型患者缩短治疗疗程的可能性。
