Digestive Diseases and Sciences

, Volume 52, Issue 12, pp 3418–3422

Long-Term Treatment with the Combination of Amantadine and Ribavirin in Hepatitis C Nonresponders. A Case Series

Original Paper

Abstract

In this report, we describe five cases of chronic hepatitis C that have been treated with the combination of amantadine and ribavirin for an average of 44 months, emphasizing one case where the patient showed improvement in liver biopsy after treatment, worsening on removal, then a repeated improvement with re-initiation. The five patients in this report belong to a pool of sixty patients from a 6 month pilot study using amantadine and ribavirin where treatment was subsequently continued. The mean ALT was 82.8±32 U/L pre-treatment and 33.8±17.3 U/L post-treatment (p=0.02). The mean Knodell score was 7±1 pre-treatment and 3.6±1.5 post-treatment (p=0.13). The mean viral load was 584,155±248,027 lU/ml pre-treatment and 225,878±190,143 IU/ml post-treatment (p=0.05). In this case series we provide provocative data on the long-term use of ribavirin and amantadine in the HCV non-responder.

Keywords

Hepatitis C Nonresponder Amantadine Ribavirin Treatment 

References

  1. 1.
    Shepard CW, Finelli L, Alter MJ (2005) Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 5:558–567PubMedCrossRefGoogle Scholar
  2. 2.
    Alter MJ, Margolis HS, Krawczynski K, et al (1992) The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic non-A, non-B Hepatitis Study Team. N Engl J Med 327:1899–1905PubMedCrossRefGoogle Scholar
  3. 3.
    McHutchison JG, Gordon SC, Schiff ER, Shiffman ML, Lee WM, Rustgi VK, Goodman ZD, Ling MH, Cort S, Albrecht JK (1998) Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis Interventional Therapy Group. N Engl J Med 339:1485–1492PubMedCrossRefGoogle Scholar
  4. 4.
    Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, Goodman ZD, Koury K, Ling M, Albrecht JK (2001) Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomized trial. Lancet 358:958–965PubMedCrossRefGoogle Scholar
  5. 5.
    Zeuzem S, Feinman SV, Rasenack J, Heathcote EJ, Lai MY, Gane E, O’Grady J, Reichen J, Diago M, Lin A, Hoffman J, Brunda MJ (2000) Peginterferon alfa-2a in patients with chronic hepatitis C. N Engl J Med 343:1723–1724CrossRefGoogle Scholar
  6. 6.
    Fontana RJ (2004) Nonresponders to hepatitis C virus antiviral therapy: pegylated interferons and beyond. Gastroenterol Clin North Am 33:527–547PubMedCrossRefGoogle Scholar
  7. 7.
    Ahmed F, Jacobson IM (2004) Treatment of relapsers after combination therapy for chronic hepatitis C. Gastroenterol Clin North Am 33:513–526PubMedCrossRefGoogle Scholar
  8. 8.
    McHutchison JG, Dev AT (2004) Future trends in managing hepatitis C. Gastroenterol Clin North Am 33:S51–S61PubMedCrossRefGoogle Scholar
  9. 9.
    Chan J, O’Riordan K, Wiley TE (2002) Amantadine’s viral kinetics in chronic hepatitis C infection. Dig Dis Sci 47:438–442PubMedCrossRefGoogle Scholar
  10. 10.
    Smith JP, Riley TR 3rd, Bingaman S, Mauger DT (2004) Amantadine therapy for chronic hepatitis C: a dose escalation study. Am J Gastroenterol 99:1099–1104PubMedCrossRefGoogle Scholar
  11. 11.
    Smith JP (1997) Treatment of chronic hepatitis C with amantadine. Dig Dis Sci 42:1681–1687PubMedCrossRefGoogle Scholar
  12. 12.
    Smith JP, Riley TR 3rd, Devenyi A, Bingaman SI, Kunselman A (2004) Amantadine therapy for chronic hepatitis C. J Gen Intern Med 19:662–668PubMedCrossRefGoogle Scholar
  13. 13.
    Veldt BJ, Brouwer JT, Adler M, Nevens F, Michielsen P, Delwaide J, Hansen BE, Schalm SW, Benelux Study Group on Treatment of Chronic Hepatitis C (2003) Retreatment of hepatitis C non-responsive to interferon. A placebo controlled randomized trial of ribavirin monotherapy versus combination therapy with ribavirin and interferon in 121 patients in the Benelux. BMC Gastroenterol 3:24 [online]Google Scholar
  14. 14.
    Bodenheimer HC, Lindsay KL, Davis GL, Lewis JH, Thung SN, Seeff LB (1997) Tolerance and efficacy of oral ribavirin treatment of chronic hepatitis C: a multicenter trial. Hepatology 26:473–477Google Scholar
  15. 15.
    Mathew A, Birkhotz J, Vidhyarthi J, Smith JP, Taheri MR, Riley TR (2007) Combination therapy with oral amantadine-HCl and ribavirin for chronic hepatitis C in non-interferon candidates (in press)Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of MedicinePenn State University, The Hershey Medical CenterHersheyUSA
  2. 2.Penn State UniversityThe Hershey Medical CenterHersheyUSA
  3. 3.HersheyUSA

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