Which patients with genotype 1 chronic hepatitis C can benefit from prolonged treatment with the ‘accordion’ regimen?

Sustained virological response rates in treatment-naïve genotype 1 patients receiving 48 weeks of therapy with peginterferon alfa-2a (40kDa) plus ribavirin 1000 or 1200mg/day in a large, randomised, multicentre study [2]. A low HCV RNA level was defined as ⩽800,000IU/mL.

Range of possible virological responses in patients with chronic hepatitis C treated with the combination of pegylated interferon plus ribavirin.

The ‘accordion’ effect. The time required for HCV RNA clearance affects the overall duration of therapy needed to obtain SVR. Based on data from several prospective studies .

Frequency of virological relapse rates in patients with rapid and slow virological responses at weeks 4 and 12. Patients in group A were treated for 48 weeks and patients in group B were treated for 72 weeks with peginterferon alfa-2a (40kDa) 180μg/week plus ribavirin 800mg/day in a large, randomised, multicentre study.

Sustained virological response rates and virological relapse rates in patients randomised to 48 or 72 weeks of therapy with peginterferon alfa-2a (40kDa) plus ribavirin 800mg/day. Only patients who were HCV RNA detectable (>50IU/mL) at week 4 were randomised [19].

Proposed algorithm for the selection of genotype 1 patients for extended treatment based on published data .