Chow W C, Boyer N, Pouteau M, Castelnau C, Martinot-Peignoux M, Martins-Amado V, Degos F, Maghinici C, Sinegre M, Benhamou J P, Degott C, Erlinger S, Marcellin P
INSERM U 481 and Centre Claude Bernard de Recherche sur les Hépatites virales, Hôpital Beaujon, Clichy, France.
Hepatology. 1998 Apr;27(4):1144-8. doi: 10.1002/hep.510270432.
Treatment of patients with chronic hepatitis C has had limited success because of relapses and nonresponse to interferon alfa therapy (currently the only established therapeutic agent). A retrospective study was done to determine the efficacy of re-treatment with interferon and the predictors of response in patients who failed to achieve sustained response after one standard course of interferon therapy (3 million units three times a week for 24 weeks). One hundred and eleven patients (47 relapsers and 64 nonresponders), mean age 45 years, were included in the study. Eighteen relapsers and 13 nonresponders received a higher dose (5 MU), and 11 relapsers and 6 nonresponders received a longer duration (48 weeks) of interferon therapy. The remaining patients received the same regimen as the first treatment. Eighty-one percent and 23% of relapsers and nonresponders, respectively, had an end-of-treatment response, and 19% and 3% of the corresponding patient groups had a sustained response to re-treatment. Two patients with breakthrough during their first treatment were the only nonresponders with sustained response after re-treatment. Sustained response was observed only in patients who received an increased dose or duration of interferon therapy. No predictor of sustained response was found. In conclusion, sustained response to re-treatment with interferon was only observed with augmentation of dose or duration of therapy in some relapsers and patients who had breakthrough. Established predictors of response to interferon in naive patients, in particular serum hepatitis C virus RNA and genotype, were not associated with sustained response to re-treatment.
由于复发以及对干扰素α治疗（目前唯一已确立的治疗药物）无反应，慢性丙型肝炎患者的治疗成效有限。开展了一项回顾性研究，以确定对在一个标准疗程干扰素治疗（每周三次，每次300万单位，共24周）后未实现持续应答的患者进行再治疗的疗效以及应答的预测因素。该研究纳入了111名患者（47名复发者和64名无反应者），平均年龄45岁。18名复发者和13名无反应者接受了更高剂量（5MU）的干扰素治疗，11名复发者和6名无反应者接受了更长疗程（48周）的干扰素治疗。其余患者接受与首次治疗相同的方案。复发者和无反应者分别有81%和23%在治疗结束时有应答，相应患者组分别有19%和3%对再治疗有持续应答。两名在首次治疗期间出现突破的患者是再治疗后仅有的有持续应答的无反应者。仅在接受了增加剂量或延长疗程的干扰素治疗的患者中观察到持续应答。未发现持续应答的预测因素。总之，仅在部分复发者和出现突破的患者中，通过增加治疗剂量或延长疗程才观察到对干扰素再治疗的持续应答。在初治患者中已确立的对干扰素应答的预测因素，尤其是血清丙型肝炎病毒RNA和基因型，与对再治疗的持续应答无关。
