This meta-analysis of six major randomized controlled trials (five from European university-based referral centers and one Asian study) looked into whether adding ribavirin to IFN therapy improves the control of hepatitis C in patients with or without cirrhosis. Outcomes in these studies, which individually were reported from 1991 to 1998, were analyzed by Dr. Solko Schalm and colleagues from centers in Europe and Taiwan and presented in volume 117 of Gastroenterology. Included were all randomized trials done in this period that included an IFN-ribavirin arm for comparison with IFN monotherapy.

Combined treatment with IFN-alpha (3 MU 3 times a week) and ribavirin (1 to 1.2 g daily) was given for 6 months to a total of 197 patients, while 147 others received only IFN-alpha for the same period. When estimating treatment effects by logistic regression analysis, previous IFN treatment was taken into account, along with the presence or absence of cirrhosis and patient genotype (genotype 1 or genotypes 2/3).

-- Patients without cirrhosis did substantially better on combined treatment than when given IFN alone. Considering previously untreated patients, rates of sustained response were 33% and 8%, respectively, for genotype 1 patients, and 65% and 24% for genotype 2/3 patients.

-- For patients with cirrhosis, sustained responses again were more likely when IFN was combined with antiviral therapy, though response rates were considerably lower in all groups. Genotype 2/3 patients, whose prognosis was relatively favorable, responded 24% of the time when given combined treatment but only 5% of the time with IFN alone. The respective rates for genotype 1 patients were 7% and 1%.

-- Combination therapy also prevented relapses more effectively than IFN monotherapy.

-- Patients tolerated combination therapy similarly whether or not they had cirrhosis. Patients with chronic hepatitis C, both those with and those without cirrhosis, do better when given both interferon and antiviral teatment than with IFN alone. This seems likely to become the regimen of choice for cirrhotic patients.