Treatment with α interferon is widely recommended for chronic hepatitis C.¹ However, the clinically relevant outcome of sustained response—that is, no HCV RNA in serum by PCR and normalisation of alanine aminotransferase (ALT) persisting after treatment for more than 6 months—is found in only about 15% of patients. Lower response rates are observed in patients with genotype 1, those with a high viral load, or cirrhosis at start of therapy.² Ribavirin is an oral nucleoside analogue that lowers serum ALT in chronic hepatitis C but its effect on HCV replication is minimal.

Reichard et al carried out a large, double blind, randomised controlled trial to assess the efficacy and safety of combination therapy with interferon and ribavirin. One hundred consecutive patients without previous treatment with interferon or ribavirin entered the trial and received either α interferon 3 MU three times weekly plus placebo daily, or interferon plus ribavirin 1–1.2 g daily for 24 …