Dear
Editor:
My
patient who at 9 months of pegintron high dose Rebetol
(600 bid) had a gastroenteritis and held meds for 3 days. Her hep c RNA bumped to 8500 after having
been undetectable for over 7 months, she has 8 more doses to complete 48 weeks
and I wonder if these finding suggests we should extend her course beyond 48 weeks. Any advice or similar experience would be
appreciated.
G S,
MD
Dear
GS:
Your
patient has demonstrated that she will likely relapse after completion of
therapy, since she had a prompt rise of HCV RNA after being a treatment
responder for 9 months of therapy. There is probably a low likelihood that 3
additional months will lead her to be a sustained virological responder. Thus,
you could consider, after discussion with her and depending upon her tolerance
to therapy, genotype (I presume genotype 1) and viral load (particularly if
high), to treat for 3-6 months longer than the usual 12 month course of therapy
to increase the chance of a sustained response. There are no direct data to
indicate how likely additional therapy would increase her chance of not relapsing,
but this therapeutic approach is an option. Historical data has suggested that,
for several types of interferon regimens, longer therapy results in some higher
percentage of patients having a sustained response.