final program.qxd - Parallels Plesk Panel

that extension of the treatment duration to 72 weeks in genotype 1 patients reduces the
risk of relapse compared with a standard (48-week) treatment duration.(32). Improved
response rates were also seen in recent study where patients without an RVR at week 4
underwent an extended duration of treatment (33). The results of studies investigating a
longer treatment duration among previous non-responders are awaited with interest,
particularly among the population of relapsers.
An ongoing international trial evaluating REtreatment with PEgasys in pATients not
responding to prior peginterferon alfa-2b/ribavirin combination therapy (REPEAT), is
currently underway. The study, which evalutes four different retreatment approaches, will
assess whether a high fixed-dose 12-week induction regimen of 360 g/week
peginterferon alfa-2a (40KD) combined with ribavirin, treatment extension beyond 48
weeks, and a high fixed-dose induction coupled with a longer treatment duration, are
associated with a greater SVR rate than a standard dose of peginterferon alfa-2a (40KD)
(180 g/week) plus ribavirin given for the standard duration of treatment (48 weeks)(31).
The study will provide a long-awaited insight into whether patients who have failed to
eradicate HCV with pegylated inteferon combined with ribavirin can benefit from
retreatment with a different drug from the same therapeutic class. Preliminary results at
week 12 suggest a higher rate of early virological response with induction dose (60%) as
compared to standard dose (42%). A similar study that is designed to evaluate the
efficacy and safety of peginterferon alfa-2b plus ribavirin in patients who either did not
respond or relapsed following treatment with peginterferon alfa-2a (40 KD) and ribavirin is
also underway.
ABSTRACTS
Maintenance therapy
Despite the overall modest SVR rate reported to date in the retreatment of non-responders,
it is important to consider other potential benefits associated with pegylated interferon
therapies. It has been shown that although histological improvement generally occurs to
a greater extent in those achieving an SVR, patients who fail to eradicate HCV may still
experience an improvement in liver histology (21,34-36). As the primary aim of treating
chronic hepatitis C is to reduce the risk of liver-related morbidity and mortality, histological
improvement should be considered an important goal in all patients, especially those with
advanced fibrosis or cirrhosis who may have failed to achieve an SVR during initial
treatment.
Maintenance therapy, which utilises drugs with an antifibrotic action over a long treatment
duration, has thus become the focus of a number of clinical trials. The objective of
maintenance therapy is to delay, or even reverse the progression of hepatic fibrosis, thus
preventing cirrhosis and its associated complications(12,14, 37). Due to the long duration
of therapy, this approach should be reserved for patients with significant fibrosis or
cirrhosis. If a patient has previously failed to respond to conventional interferon-based
therapy, and retreatment with pegylated interferon combination therapy at the correct dose
and duration has been unsuccessful, then maintenance therapy should be considered.
Early studies evaluating the potential benefits of maintenance therapy in non-responders
provided the first indication that prolonged administration of interferon monotherapy may
prevent histological progression of chronic hepatitis C among patients who remain
viraemic (38). Clinical trials are currently underway to explore the effect of pegylated
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