Hepatitis C - peginterferon alfa and ribavirin
Peginterferon alfa and ribavirin for the treatment of mild chronic hepatitis C (TA106)
1. Guidance
NICE issued guidance on the use of interferon alfa, pegylated interferon alfa (peginterferon alfa) and ribavirin in the treatment of people with moderate to severe chronic hepatitis C in January 2004 (NICE technology appraisal guidance 75; TA 75). The evidence in this appraisal relates to the extension of this treatment to people with mild chronic hepatitis C. For people with moderate or severe disease, the guidance in TA 75 still stands.
1.1. Combination therapy, comprising peginterferon alfa-2a and ribavirin or peginterferon alfa-2b and ribavirin, is recommended, within the licensed indications of these drugs, for the treatment of mild chronic hepatitis C.
1.2. Monotherapy with peginterferon alfa-2a or peginterferon alfa-2b is recommended, within the licensed indications of these drugs, for the treatment of mild chronic hepatitis C for people who are unable to tolerate ribavirin, or for whom ribavirin is contraindicated.
1.3. The decision on whether a person with mild chronic hepatitis C should be treated immediately or should wait until the disease has reached a moderate stage (‘watchful waiting’) should be made by the person after fully informed consultation with the responsible clinician. The decision to treat need not depend on a liver biopsy to determine the stage of the disease if treatment is initiated immediately. However, a biopsy may be recommended by the clinician for other reasons or if a strategy of watchful waiting is chosen.
1.4. The duration of treatment should vary according to the licensed indications of the chosen drug, the genotype of the virus, the initial viral load, the response to treatment, and the treatment regimen chosen.
1.5. Second or subsequent courses of treatment are not recommended for people who have been treated with a first course of either combination therapy or monotherapy with peginterferon alfa if they have not had an early response (as indicated by reduction in viral load at 12 weeks).
1.6. There is insufficient evidence to recommend combination therapy or monotherapy with peginterferon alfa for people with mild chronic hepatitis C who are under the age of 18 years, or those who have had a liver transplant.
