Specific Treatment Polulations continued:
Relapsing patients:
The role of combination therapy for patients who have previously been treated with interferon (monotherapy) has not yet been resolved. The current data indicates support for treatment of relapsing patients with combination therapy. However, it is still unclear as to whether a 48-week treatment regimen should be used or a 24-week regimen. Further information regarding the genotype, viral load and liver biopsy findings will be useful in determining this information. In this patient population, many physicians recommend a repeat liver biopsy to assess the current state of the liver.
Non-responders:
Patients who are non-responders to monotherapy do not respond well to combination therapy. However, some patient have been reported to respond to combination therapy. The current volume of data regarding these groups of patients is limited making exact recommendations difficult. This group of patients is often times included in clinical trials.
New Treatment Regimens:
At present, the treatment regimens for hepatitis C have improved significantly over the past 15 years. Current research protocols are designed to maximize the response rates associated with currently available effective medical therapy. These approaches include use of different types of interferon, induction therapy and long acting interferon (pegylated interferon).
Induction therapy is a technique of introducing a higher dose of interferon to the patient during initiation of treatment. Usually, interferon is administered to the patient on a daily basis. The duration of this daily administration is variable and is usually governed by the research protocol in which a patient is enrolled. Duration of these studies is usually 48 weeks (twelve-month). The studies may or may not include use of ribavirin.
Pegylated interferon is a long acting preparation that requires subcutaneous injection on a weekly basis. Studies are currently being performed as both monotherapy and combination therapy (with ribavirin) for relapsing and non-responders. Naive patients are not currently being treated due to limited availability of pegylated interferon.
Currently, research protocols are available through Colorado Center for Digestive Disorders. Please go to the research button for further information regarding protocols that are currently available.
Side Effects and Treatment Labs
During treatment, a CBC and liver function tests are obtained at 2 weeks and 4 weeks. Subsequently, CBC and liver panels are drawn on a monthly basis. Usually, patients are seen once a month during the first two months of treatment. A follow up appointment every 2 to 3 months thereafter is scheduled if the patient is doing well. Certainly, if further problems arise the patient is seen earlier. Some controversy exists about the timing of viral load determinations during treatment of Hepatitis C.
Some authors advocate using a viral load at 3 months to determine whether continued medication should be administered to the patient. This approach allows the physician to determine whether the patient is responding to the medication by comparing pretreatment and treatment viral load values. If a significant decrease in viral load has been accomplished, the medication is continued. A viral load may be repeated at 6, 9 and 12 months depending upon the specific situation.
During the treatment, a thyroid function test (TSH) is obtained usually approximate six months. If there is evidence of hypothyroidism, institution of Synthroid is usually carried out.
Common side effects associated with interferon include:
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Chest pain/shortness of breath. |
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Ringing in the ears. |
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Diarrhea and vomiting. |
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Decreased appetite. |
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Aches and pains in the muscles and joints (arthralgias and myalgias). |
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Anxiety. |
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Difficulty concentrating. |
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Insomnia. |
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Irritability. |
Common side effects associated with ribavirin:
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Breakup of red blood cells (hemolysis). |
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Abdominal pain. |
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Sore throat, shortness of breath, cough and sinusitis. |
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Itching and skin rash. |
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Other Liver Pages:
- Acute Acalculus Cholecystitis |
Acute Calculus Cholecystitis |
Albumin |
Alcoholic Cirrhosis |
Alcoholic Liver Disease |
Alpha 1 Antitrysin Deficiency |
Autoimmune Hepatitis |
Bilirubin |
Common Bile Duct Stones |
Esophageal Varices |
Gallstones |
Hemochromatosis |
Hepatitis G Virus |
Hepatitis - General |
Hepatitis A |
Hepatitis B |
Hepatitis C |
Hepatitis D |
Hepatitis E |
Iron Overload Diseases |
Primary Biliary Cholangitis |
Primary Sclerosing Cholangitis |
Wilson's Disease
Related Links
- Definitions |
Liver Function Tests
Patient Education:
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