Treatment discontinuation with peg-interferon: what to consider

Abstract

Eradication of chronic hepatitis C virus infection improves the outcome of both liver and extrahepatic-related diseases and interferon-based regimens represented, for years, the standard of care to achieve this goal. Several baseline and on-treatment predictors of response, associated with a lower chance to achieve sustained virological response after interferon-based treatment, were developed. In the past few years, the advent of direct acting antivirals has dramatically modified the landscape of antiviral therapy, leading to an evolution from interferon-based to interferon-free therapies. This review will focus on the usefulness of futility stopping rules that allow the discontinuation of therapy in patients with a reduced chance to obtain sustained virological response if treated with interferon-containing regimens.

Keywords:

• futility stopping rules
• hepatitis C virus infection
• interferon-based regimens
• predictors of response
• sustained virological response
• treatment discontinuation

Financial & competing interests disclosure

V Boccaccio is on the advisory board for Abbvie. M Russo is on the advisory board for Janssen-Cilag. S Bruno is on the advisory board for Abbvie and Merck Sharp & Dohme and speaker bureau for Merck Sharp & Dohme, Abbvie, Gilead and Janssen-Cilag. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Sustained virological response improves the outcome of hepatitis C virus-related liver disease.

• Pegylated interferon plus ribavirin has been for years the standard of care for treatment of hepatitis C virus.

• Baseline and on-treatment predictors of response are useful to identify patients with a low chance to achieve sustained virological response if treated with interferon-based regimens.

• On the basis of these predictors, futility stopping rules have been developed to discontinue early interferon-based treatments, sparing costs and avoiding potential adverse events.