派罗欣和利巴韦林治疗失败：再治疗是否是一种选择？

 

　目前，派罗欣联合利巴韦林治疗失败的患者的治疗选择有限，一个选择是采用聚乙二醇联合利巴韦林第2个疗程再治疗。然而，这个选择的病毒清除情况尚不清楚。因此，我们评估了一组患者，他们在首个聚乙二醇联合利巴韦林治疗无应答而在第2个疗程后获得了持续病毒学应答。治疗无应答定义为在第12周未能获得早期病毒学应答，或在第24周或完成聚乙二醇联合利巴韦林治疗后检测到HCV-RNA。20例（12例男性，8例女性）曾接受派罗欣α-2b联合利巴韦林或派罗欣联合利巴韦林的治疗。平均年龄为50岁，85%是白种人，95%是基因1型，35%有肝硬化。在首个派罗欣联合利巴韦林疗程前，12例（60%）患者未接受过丙肝治疗。在第2个疗程后，2例（10%）获得了持续病毒学应答。这些结果显示在首个派罗欣联合利巴韦林治疗无应答的慢性丙肝患者中在接受第2个疗程治疗可获得边际效益。

Dig Dis Sci. 2007 Mar;52(3):732-6.

Pegylated interferon and ribavirin failures: is retreatment an option?

Cheruvattath R, Rosati MJ, Gautam M, Vargas HE, Rakela J, Balan V.

Division of Gastroenterology and Hepatology, Transplant Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, Arizona 85259, USA.

Currently, there are limited therapeutic options available for chronic hepatitis C (HCV) patients who fail treatment with peginterferon alpha (PEG IFN) + ribavirin (RBV). An option is retreatment with a second course PEG-IFN + RBV. However, the virologic clearance with this option is unknown. Thus, we evaluated the outcome of our cohort of patients with chronic HCV who achieved a sustained viral response when retreated with PEG IFN plus RBV after having no response to an initial course of PEG IFN plus RBV. Nonresponse to treatment was defined as failure to achieve an early virologic response by week 12 or presence of detectable HCV RNA at week 24 or after completion of PEG-IFN + RBV therapy. Twenty patients (12 [60%] men; 8 [40%] women) were treated with PEG IFN alpha-2b plus RBV and PEG IFN alpha-2a plus RBV. The mean age of the patients was 50 years, 85% were white, 95% had genotype 1, and 35% had cirrhosis. Prior to the first course of PEG IFN plus RBV, 12 (60%) of 20 patients had no prior treatment for Hepatitis C. After the second course of PEG IFN plus RBV, 2 (10%) of 20 patients achieved a sustained virologic response. These results suggest marginal benefit of retreatment of patients with chronic HCV with another course of PEG IFN plus RBV after they have not responded to an initial course of PEG IFN plus RBV.

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