This meta-analysis was conducted to assess the efficacy and safety of interferon and ribavirin combination therapy (CT) versus interferon monotherapy (IMT) in inducing sustained response in interferon-naïve, relapser, and nonresponder chronic hepatitis C patients. A literature search was performed using the MEDLINE database for clinical trials published in the period between 1995 and 2003. A total of 31 randomized trials and 7 nonrandomized trials comparing CT with interferon alone or comparing different dose regimens of CT were included in this meta-analysis. The primary outcome measure was sustained virological response. The summary estimate of the odds ratio was obtained using the random effect model. The study showed that sustained virological response rate was significantly higher in interferon-naïve, relapser, and nonrespondent chronic hepatitis C patients who were on CT compared to IMT (odds ratio = 3.23, 17.65, and 4.71, respectively). There was no statistically significant difference in virological and biochemical responses between different dose regimens of CT. Side effects, dose reduction, and treatment discontinuation rates were significantly higher in patients receiving CT compared with IMT. Treatment with interferon plus ribavirin has a significant benefit on the virological and biochemical response in patients with chronic hepatitis C irrespective to the previous treatment, and it should be considered the treatment of choice in naïve, relapser, and nonrespondent chronic hepatitis C patients.
High-dose prolonged combination therapy in non-responders to interferon monotherapy for chronic hepatitis C
