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Should you take maintenance interferon if you are a nonresponder? More than half of American patients treated for hepatitis C do not respond to any antiviral therapy. They have a partial fall in their HCV-RNA that is temporary. We cannot cure the infection in these patients using current therapy. Many years ago, Dr. Mitchell Shiffman
proposed that some nonresponders obtain
from interferon even without viral eradication. This led to
the
the NIH was reported at AASLD 2007. It did not show any survival benefit from maintenance interferon. This was a large multicenter trial that was designed by excellent hepatologists. Since the risk of death, liver cancer and liver failure was the same whether a patient was given maintenance interferon or not, very few nonresponders will choose this treatment. Instead, they will wait for new drugs to be available. Another trial called
patients who achieved sustained viral response had excellent survival, even those with liver failure. The patients who did not achieve sustained viral response had poor survival. Patients with a temporary response had no survival benefit. There was no survival benefit to patients who had received more interferon compared with those who received less interferon. My VA data shows that if you cure the infection you improve survival and treatment without cure does not help survival at all. My current thoughts on maintenance interferon are that nonresponders with cirrhosis should make certain that they have tried everything FDA approved to attempt cure, specifically Pegasys, Infergen 15 mcg daily, and PegIntron. Many of my patients have failed all three of these medicines. I hope that HCV protease inhibitors and other new drugs will cure these patients. If you are interested in survival like I am, read my
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