What are the combination therapy options?
What does combination therapy involve?
I'm talking about ribavirin (Rebetol), which is a nucleoside analogue with a broad spectrum of antiviral activity against RNA viruses. This is licensed for use in combination with either interferon a 2a or 2b in treatment of hepatitis C in two main groups.
Adult patients with previously untreated, histological proven hepatitis C but with no liver decompensation must be positive for serum HCV-RNA, as well as having high inflammatory activity or fibrosis.
A second group is adult patients with chronic hepatitis C who have previously responded to interferon a (their
ALT levels had normalised) but who unfortunately relapsed when treatment stopped.
Ribavirin is given orally and regular monitoring of liver function and haematological parameters is a prerequisite, as is genotype testing to check which
specific type of hepatitis C is affecting the patient.
Who is ineligible for combination therapy?
Treatment involving repairing and interferon a, alone or together, is not generally recommended for hepatitis C positive patients who are heavy users of alcohol because of the risk of increasing liver damage.
Continuing intravenous drug abusers are ineligible, although former abusers, including those on maintenance drug treatment, can be considered. There is currently insufficient evidence for recommendations about patients under the age of 18, or those who have had a liver transplant.
But we are now at a point where interferon a monotherapy should only be considered when repairing is either not tolerated or is contraindicated.