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3.1.4b Maintenance Dosing

Maintenance therapy with low-dose peginterferon may reduce the risk of developing decompensated cirrhosis and liver cancer in people with advanced fibrosis. Up to 40% of these patients can experience a histological response (improvement in liver tissue damage) even if they do not achieve an undetectable viral load. Several studies are underway looking at whether long-term peginterferon monotherapy is a beneficial option for people with advanced liver disease ( http://hepcassoc.org/news/article71.html

The NIH has begun the HALT-C trials to test long-term pegylated IFN monotherapy in non-responders. The results will not be available for several years. Another ongoing study is called “Copilot”. These studies are expected to prove the effectiveness of maintenance therapy ( www.natap.org, Treating Hard To Treat Patients, Reported by Jules Levin).

A trial involving 12 post-transplant patients showed that low, daily dose interferon maintenance was generally tolerable. Inflammation (predominantly portal inflammation) improved and fibrosis was stable at the end of therapy in treated patients, with no quasispecies diversification in most cases. Controls showed no change or increased inflammation and fibrosis. These findings provide a rationale to study low dose daily or pegylated interferon maintenance therapy for the management of hepatitis C post-transplant (Transplantation. 2001;71:261-266).



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