PG-IFN and Ribavirin Treatments

When patients come to see me, one of most common questions is whether he or she should try the newly approved PG-IFN and Ribavirin treatments.  I think the answer depends on the individual and their disease condition. Generally speaking, for any new therapy, there will be a learning curve involved, including the observation of short-term and long-term side effects. The evaluation period may take several years before its efficacy can be accurately assessed. For chronic conditions such as Hepatitis C where the patient’s condition can remain stable for long periods of time, it may be better to wait before taking on a new treatment.

For an individual patient to make the decision on whether to take the new PG-IFN based treatment, a few important questions should be addressed regarding the purpose of the treatment and the profile of the patient. The usual consideration factors are: gender, age, virus geno-type, viral load, stage of fibrosis, autoimmune disorders, and previous experience with similar IFN based treatments. As for the purposes of different treatment routes, eradication of the virus is the focus of IFN based treatments while alternatives such as our protocol aim to prevent the progression of fibrosis and restore liver functions.

Generally, the ideal candidate for PG-IFN and Ribavirin based treatments is a female patient, under 40, with viral load less than 2 million copies per/ml, geno-type not 1a or 1b, fibrosis stage around 2 to 3, no autoimmune disorders, and no previous experience with similar treatments. Her chance for response can be a round 70% or higher and I would recommend her trying the new treatment if she is prepared for the side effects. The worst candidate is a male patient over 60, with a viral load over 2 million/ml, fibrosis stage 4(cirrhosis), genotype 1a or 1b, and having a failed response from a previous IFN based treatment. For this patient, the response rate on the new PG-IFN and Ribavirin treatment would be around 10% or less and I would recommend using an alternative protocol to control the inflammation, halt the progression fibrosis and keep the stability of the compensated cirrhosis stage. Most patient profiles hover between these two examples and the decision to try PG-IFN and Ribavirin should be made based around these factors.

In Washington, during the second consensus development conference held in June 2001, experts found that the total percent of patients eligible for taking IFN-based treatments is only about 30%, mainly due to the potential side effects. For those eligible patients, the overall efficacy of the IFN-based treatments is only about 50%. Thus, it is obvious that the majority of viral hepatitis patients still need alternative methods before a complete cure is found. Our goal is to provide those patients with an alternative protocol so the progression of the disease can be controlled while their life quality can be sustained at normal levels.