Weekly Pegylated Interferon a-2b vs daily Interferon a-2b versus standard regimen of Interferon a-2b in the treatment of patients with chronic hepatitis C virus infection

Background and study aims : The combination of Pegylated (PEG)interferon a-2b and ribavirin is considered to be the stan- dard treatment for naïve chronic hepatitis C patients. Study aims are to evaluate the differences between standard interferon and PEG-interferon by conducting a multi-centre, controlled random- ized trial comparing 3 groups. Group A : daily interferon alfa-2b at a dose of 4 MIU + ribavirin, Group B : PEG-interferon alfa-2b at a dose of 100 mcg/week + ribavirin ; Group C : interferon alfa-2b at a dose of 3 MIU TIW + ribavirin Patients and methods : Multicentrer, open label study including naïve chronic Hepatitis C Virus patients randomised in three groups with a ratio of 2:2:1. Group A : daily interferon a-2b (4MIU s.c. for patients >65kg or 0.06 MIU/kg<65kg) and ribavirin, group B : PEG-interferon a-2b (100 µg s.c. weekly for patients > 65 kg or 1.5 µg/kg weekly for patients < 65 kg) and ribavirin and group C (reference arm) : interferon a-2b (3MIU s.c. TWI) and ribavirin. The duration of the treatment was 48 weeks for all 3 groups, with a 6 month follow-up period. 336 patients were enrolled in the study and included in the intention-to-treat analy- sis ; 78 never started treatment (35 in group A, 28 in group B and 15 in group C) : 101 in group A, 98 in group B and 59 in group C. Results : Demographic data, PCR results and reasons for early withdrawal have been statistically analysed. At baseline, the 3 groups did not show any statistical difference regarding age, gender, race, genotypes and METAVIR score. At week 24 on treat- ment, HCV ribonucleic acid RNA was undetectable in 87% in group A, in 79% in group B and in 69% in group C. At the end of treatment, 73% 74% and 58% respectively, had a negative PCR result. At week 24 of follow-up, these results were 71%, 64% and 48%, respectively. When comparing the efficacy of the daily inter- feron (+ ribavirin) and the PEG-interferon (+ ribavirin) regimen, no statistical difference was found (p = 0.32). In group A, 38% of drop-outs were due to adverse events compared to 37% in group B and 58% in group C. No statistical differences were observed regarding safety. Conclusion : Daily weight based interferon a-2b dosing and PEG interferon a-2b weighed based dosing once weekly both in combination with Ribavirin offer the same efficacy and safety rates. (Acta gastroenterol. belg., 2008, 71, 293-297).