According to a new study, patients who do not respond to initial standard drug treatment for hepatitis C are unlikely to respond to long term maintenance therapy using low-dose peginterferon as well. Many patients who do not respond well to initial medication are placed on maintenance therapy in the attempt to keep the disease in control, which is both expensive and can be physically and psychologically trying.

Lead author, Dr. Adrian M. Di Bisceglie, professor of internal medicine and co-director of the liver center at St. Louis University School of Medicine said, "This course of treatment had been adopted by a number of doctors in the U. S. and in other countries, though it had yet to be proven to work. That practice should be stopped, based on the results of this trial. There is no rationale for using maintenance therapy. The treatment is clearly ineffective."

In the study which involved a total of 1050 non-respondent patients with advanced liver disease half were given low doses of peginterferon for 3.5 years to try to suppress the hepatitis C virus and slow the progression of liver disease while the remaining patients were assigned to a control group. After four years it was noted that patients on long-term peginterferon fared just as poorly as non-responders who were not taking the drug. 30 % of the patients in both the groups had developed liver failure, liver cancer, or had died while those who had milder cirrhosis at the start of the study, 10 % to 12 % developed severe liver disease. Eight patients on peginterferon died, compared with two who were not taking the drug, a statistically significant difference, researchers said.

"Hepatitis patients in these circumstances got very ill over the course of four years, surprisingly so. The lesson we learned is that once chronic hepatitis C gets to the stage of advanced fibrosis, patients can decline rapidly," De Bisceglie said. The study was conducted at numerous medical centers and supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

Dr. Howard Worman, professor of medicine at Columbia University College of Physicians and Surgeons, who was not involved in the study said, "This is a treatment that should not be done. Patients should just sit tight and wait for new treatments or drugs to be added, which will happen within a few years."

The report appears in Thursday's issue of The New England Journal of Medicine.