Finally: changing the natural history of chronic hepatitis c

Previous studies have established the benefit of combined interferon and ribavirin therapy in achieving sustained virological clearance in chronic hepatitis C infection. Interferon has antifibrotic activity, but the added benefit of the combination regimen for the progression of liver fibrosis is unknown. The authors pooled individual data from three large, multicenter, randomized studies of combined interferon alfa-2b and ribavirin involving 1509 patients with pre- and posttreatment liver biopsies. Fibrosis was staged on a scale of 0 to 4: F0, no fibrosis; F1, portal fibrosis without septa; F2, few septa; F3, numerous septa without cirrhosis; and F4, cirrhosis. F2, F3, and F4 were considered significant fibrosis. Liver biopsies were done before and 1 yr after therapy, and the rates of progression or regression of fibrosis between the two biopsies were calculated. Ninety-six weeks after the initial biopsy, 68 ± 4% of patients were without significant fibrosis when treated with combination therapy for 48 wk, 64 ± 4% were without significant fibrosis with interferon alone for 48 wk, 42 ± 7% were without significant fibrosis with combination therapy for 24 wk (lower than both 48-wk therapies, p < 0.001), and 24 ± 9% were without significant fibrosis with interferon alone for 24 wk (lower than the combination therapy for 24 wk, p = 0.02). The patients with significant fibrosis at baseline, those who achieved a virological response, and those who received 48 wk of therapy had the most prominent results. The combination of interferon and ribavirin therapy significantly reduces the rate of progression of liver fibrosis in patients with chronic hepatitis C.