Page 45 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral therapy in non-responders, relapsers and special populations | 45

load (VL) or to the patient, such as African-American or Hispanic
race, severity of liver fibrosis/cirrhosis, hepatic steatosis or
insulin resistance (IR), negatively impact the therapeutic
outcome during a subsequent course of treatment. On the
contrary, identifying correctable factors that may have
contributed to prior treatment failure can help the decision of
retreatment and subsequent management. The most common
correctable factors that can significantly diminish the rate of
SVR include:
Dose reduction, transient discontinuation or premature
interruption of therapy, due to side effects such as anemia,
neutropenia or depression. Close monitoring and judicious
interventions (modest dose reduction, use of growth factors,
prophylactic antidepressants) could minimize these factors.
Lack of adherence to the prescribed medication regimen.
Rigorous adherence should be stressed and monitored.

Therapeutical strategies
The following strategies for prior genotype 1 non-responders
and relapsers can be distinguished:
1. Retreatment with PegIFN/RBV
2. Extended treatment duration for slow virological responders
3. Increasing PegIFN dose and longer treatment duration
4. Optimizing PegIFN and RBV dosing during retreatment
5. Maintenance therapy with low-dose of PegIFN
6. Triple-combination therapy

1. Retreatment with the previous regimen (PegIFN/RBV). In
the EPIC3 study, non-responders and relapsers to previous
therapy with interferon alfa (n=1203) or PegIFN alfa-2a/2b
(n=820) with or without RBV were retreated with PegIFN alfa-2b
(1.5µg/kg/week) and weight-based RBV (800-1400 mg/day) for
48 weeks (Poynard 2009). SVR was higher in prior relapsers
vs. non-responders (38% vs. 14%) and in patients who achieved