Efficacy of ribavirin monotherapy following combination therapy with interferon alfa-2b and ribavirin for patients with chronic hepatitis C

Reappearance of HCV-RNA followed by exacerbation of biochemical parameters after combination therapy consisting of interferon and ribavirin is an obstacle to achieve sustained response and improve long-term prognosis. We hypothesed that ribavirin monotherapy after 6 months of combination therapy may improve sustained viral and biochemical responses, and conducted a prospective, randomized and controlled study. Thirty-eight patients with chronic hepatitis C treated with combination therapy for 6 months and had no detectable serum HCV-RNA were enrolled, and allocated into two arms. Group I (n = 19) was continuously administered oral ribavirin for additional 6 months, and group II (n = 19) was followed up without any further treatment. At the end of trial, HCV-RNA negativity was 11/19 (58%) in group I, and 6/19 (32%) in group II (p = 0.191). Multivariant analysis demonstrated that ribavirin monotherapy was not a predictor for the eradication of HCV-RNA. In cases without sustained viral responses, serum ALT levels at baseline and the end of 48 weeks' trial were 54.6 and 44.4 in group I (p = 0.237), and significant reduction with ribavirin monotherapy was not observed. In conclusion, ribavirin monotherapy following combination therapy fails to improve sustained viral response as well as biochemical response.