Ribavirin priming in patients with chronic hepatitis C and normal ALT: a pilot study.

Background/aims: Ribavirin has favorable immune-modulating effects in patients with hepatitis C. Therefore, a ribavirin monotherapy preceding the combination of peginterferon plus ribavirin may be beneficial. We conducted a pilot study with a sequential regimen using a reduced dosage of peginterferon-alfa 2b in patients with chronic hepatitis C and normal transaminases.

Methodology: Twenty patients (17 genotype 1, 3 genotype 2/3) were treated with ribavirin for 4 wk followed by ribavirin plus peginterferon-alfa 2b 100 microg for 4 wk and ribavirin plus peginterferon-alfa 2b 50 microg for 44 wk. TH1-cytokines interferon-gamma and interleukin-2, and TH2-cytokines interleukin-4 and interleukin-10 were measured in the supernatant from PHA-stimulated lymphocytes.

Results: Sustained viral response defined as negative HCV-RNA after follow up was 50%, 41%, and 100% for all patients, genotype 1, and genotype 2/3, resp. The increase in interferon-gamma following ribavirin monotherapy was significantly higher for patients with sustained viral response.

Conclusions: The sustained viral response rate of this pilot study using ribavirin priming and reduced peginterferon dosage is in line with previous trials using standard treatment regimens for chronic hepatitis C. Our data stress the positive impact of the ribavirin-induced TH2-TH1 cytokine shift at least in patients with normal ALT. Larger clinical studies with ribavirin priming seem warranted.