What is the role of pegylated interferon and ribavirin in the treatment of hepatitis C virus (HCV) infection?

Updated: Dec 09, 2020
  • Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

Regimens containing pegylated interferon and ribavirin were the backbone of HCV therapy from 2001 until 2014. Since 2014, interferon-free therapy has been the norm. However, interferon may still play a role in particular treatment situations (eg, therapy for treatment-experienced patients infected with genotype 3). [7] Ribavirin continues to play a key role in a wide variety of HCV treatment regimens.

Below, the term pegylated interferon refers to either peginterferon alfa-2a 180 µg subcutaneously (SC) once weekly or peginterferon alfa-2b 1.5 µg/kg SC once weekly. Note that peginterferon is contraindicated for use in patients with hepatic decompensation (eg, the presence of ascites). Such patients may be at risk for worsening liver function or sepsis if treated with peginterferon.

The ribavirin dose is based on weight. The initial clinical trials with peginterferon alfa-2a utilized ribavirin at a dose of 1000-1200 mg per day (in two divided doses), [8] whereas the initial clinical trials with peginterferon alfa-2b utilized ribavirin at a dose of 800-1400 mg per day. [9] Trials published in relatively recent years that studied sofosbuvir utilized ribavirin using the following schedule: for individuals weighing less than 75 kg, ribavirin 400 mg in AM and 600 mg in PM; for individuals weighing 75 kg or more, ribavirin 600 mg twice per day. Trials that studied the elbasvir/grazoprevir combination used a different schedule: for individuals weighing less than 66 kg, ribavirin 800 mg per day; for individuals weighing 66 to 80 kg, ribavirin1000 mg per day; for individuals weighing 81 to 105 kg, ribavirin1200 mg per day; for individuals weighing more than 105 kg, ribavirin 1400 mg per day.

Ribavirin is contraindicated in women who are or may become pregnant and in men whose female partner is pregnant; this is due to the drug’s potential teratogenicity.

Monotherapy with pegylated interferon, ribavirin, or any direct-acting antiviral agent (eg, simeprevir, sofosbuvir) is not recommended, due to their lack of efficacy.


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