Interferon alfa has now been used for more than 20 years to treat chronic hepatitis C. Although effective in many patients, therapy with interferon alfa has been burdened – and limited – by its poor tolerability, often the harbinger of outright toxic effects. For the same reasons, interferon may be contraindicated ab initio, and fear of adverse reactions – whether justified or not – is another undeniable barrier to treatment for many. These reactions are even more frequent and severe in many ‘difficult-to-treat’ patients, i.e. those with cirrhosis or immunosuppressed or coinfected with HIV, not to mention the elderly. Frequently unpredictable, amazingly variable, both qualitatively and quantitatively, the side effects of interferon alfa monotherapy first, and of its combination with ribavirin later on, have formed the topic of entire review articles and scientific workshops. This attention is well deserved: adverse effects of therapy may lead to dose reduction and/or premature termination of the prescribed drug(s), hence to decreased long-term efficacy of a treatment that is very costly, in both human and economic terms.
However, at specialized centers and in experienced hands, cases of drug(s) withdrawal before the scheduled end of therapy have become infrequent, as have permanent dose reductions. The increased tolerability of the pegylated form of interferon alfa, compared to the standard form, can only partially account for this. The actual explanation lies in the improved management of side effects via effective drugs and nursing techniques. Thus, stopping treatment due to mild to moderate depression, or anemia, or dysthyroidism or even severe cutaneous complications is less and less likely an option. We have safe and efficacious drugs to combat all of these adverse reactions. Inhibitors of serotonin reuptake, erythropoietin, granulocyte colony stimulating factor, and topical steroid derivatives are more and more being used to counteract untoward effects of interferon alfa and ribavirin, and very soon also drugs capable of correcting thrombocytopenia will reach the market.
This issue of Hot Topics in Viral Hepatitis aims at providing some practical recommendations to cope with a selection of these side effects. I hope that some of the most hesitant professionals (and patients) will reconsider their reservations with respect to the therapy of a disease that is today curable in so many instances.