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Treatment of interferon non-responsive chronic hepatitis C with triple therapy with interferon, ribavirin, and amantidine can be encouraging
  1. N Khokhar
  1. Correspondence to:
    Professor N Khokhar
    Division of Gastroenterology, Department of Medicine, Shifa international Hospital and Shifa College of Medicine, Islamabad, Pakistan; drnkhokharyahoo.com

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Patients with hepatitis C virus infection who do not respond to treatment with interferon alone or its combination with ribavirin present a serious clinical challenge and there is no clear choice for treatment in these individuals.1,2 Earlier studies with antiviral amantidine, which has been used in influenza, had shown promising results.3 Now,

have shown 68% end of treatment response with induction therapy using daily interferon for four weeks (and then three injections weekly) in combination with ribavirin and amantidine hydrochloride.

We had used interferon in doses of 3 million units given subcutaneously thrice weekly with ribavirin 800–1200 mg/day and amantidine hydrochloride 100 mg orally twice a day in a small group of chronic hepatitis C patients who had not responded to a combination of interferon and ribavirin. We found a 50% end of treatment response after a treatment period of 12 months (see table 1). Half of the patients showed no effect on alanine aminotransferase or hepatitis C virus RNA, and in these patients treatment was discontinued after three months.

There are reports of good results with the use of amantidine in combination with interferon.4 Therefore, although the mechanism of action of amantidine in this setting is unclear, it is becoming obvious that there is an encouraging situation for these hard to treat patients and there may be light at the end of the tunnel. Due to lack of major sponsorship for amantidine from a large pharmaceutical company however, it may take a while before this happens.

Table 1

Patients treated with interferon, ribavirin, and amantidine

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