Is Treatment of Chronic Hepatitis C Feasible in Patients on Methadone Maintenance?
Treatment with PEG-Intron (pegylated interferon alfa-2b 1.5 mcg/kg qw) and ribavirin (800 - 1200 mg bid) lasted 6 (genotype 2, 3) or 12 months (genotype 1, 4). Median time on stable methadone maintenance was 21 months. At the end of treatment HCV RNA <600 IU/ml was reached in 21/43 methadone patients (49%) and in 32/45 (71%) controls (p=0.049, lost to follow up equals failure analysis).
Discontinuation due to non-compliance or side effects was 18/43 in methadone patients (42%) and 8/45 control patients (18%) (p=0.019). Laboratory markers (e.g. ALT, leukocytes, haemoglobin, platelets) were not different between methadone arm and control. No serious psychiatric adverse event occurred in either arm.
Conclusions: Pegylated interferon and ribavirin seem reasonably safe and sufficiently effective in patients on methadone maintenance. The lower efficacy in methadone patients is most probably due to a lower adherence. But the end of treatment result is still close to the results of the pivotal study which led to the approval of PEG-Intron and ribavirin combination therapy (Manns, Lancet 2001;358: 958-965).
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