Longer Hepatitis C Treatment Best
Cure Rates Are Higher With Longer Treatment of 6 Months
July 11, 2007 -- Shortening treatment to less than six months does not
appear to be a good strategy for patients with the most curable types of
hepatitis C virus infection, new research suggests.
Patients with hepatitis C genotypes 2 and 3 who were treated for four months
had lower cure rates and higher relapse rates than those treated for six
The study, which appears in tomorrow’s New England Journal of
Medicine, shows that longer treatment benefits even those with highly
treatable hepatitis C, researcher Mitchell L. Shiffman, MD, tells WebMD.
“I tell patients if they can tolerate treatment and can stay on it for 24
weeks, they have a better chance of achieving the best possible outcome, which
is a cure,” he says.
Hepatitis C Treatment Strategies
Long-term infection with hepatitis C virus (HCV) is a leading cause of
cirrhosis, liver cancer, and liver transplants in the United States. As many as
4 million Americans are infected, but most don’t know it, experts say.
About 70% of infected Americans carry the genotype 1 form of hepatitis C,
which tends to be less responsive to treatment than genotypes 2 and 3.
With aggressive treatment, nearly 80% of people with genotypes 2 or 3
achieve complete and sustained viral eradication, or cures, compared with about
40% to 45% of people carrying genotype 1 virus.
These days, most patients are treated with a long-acting version of the
injected drug interferon along with the antiviral drug ribavirin.
The standard course of treatment for patients with the more treatable types
of hepatitis C infection is half that of patients with genotype 1 hepatitis C
-- 24 weeks compared with 48 weeks.
In several recent studies, it was reported that shortening treatment to four
months and even three months had no impact on cure rates in hepatitis C
genotype 2 or 3 patients.
In an effort to test these findings, Shiffman and colleagues from Virginia
Commonwealth University compared outcomes among genotype 2 or 3 patients
treated for four months and six months.
They report that 31% of patients treated with the shorter course of therapy
eventually relapsed, compared with 18% of patients who got the full six months
of treatment. Relapse was defined as having detectable levels of virus in the
blood at follow-up despite complete viral eradication at the end of
Overall, 62% of patients treated for four months achieved sustained viral
responses, compared with 70% of patients treated for six months.
Among patients who achieved complete viral responses within a month of
starting treatment, 79% of those treated for four months achieved complete,
sustained responses, compared to 85% of the patients treated for six
Individualized Hepatitis C Treatment
Shiffman understands the desire of patients and doctors to shorten
treatment. The drugs used to treat hepatitis C are very expensive and they can
cause severe fatigue, fever, depression, and other hard-to-tolerate side