Maintenance therapy is the continuation of treatment even though there has not been a sustained virologic response (SVR).
There has been some evidence that continuation of treatment whilst not clearing the virus may have some beneficial effects. These are:
- Decreasing the rate of fibrosis progression
- Decreasing the rate of development of complications of end-stage liver disease
- Reducing the risk of developing HCC
Maintenance therapy is not currently funded in the UK. Since it is not yet clear how effective it is, it is not surprising that PCTs and hospitals have been unwilling to fund it.
The uncertainty about the possible benefit of maintenance led to the current HALT-C trial in the States. It's aim is to determine "if continuing interferon long term over several years will suppress the hepatitis C virus, prevent progression to cirrhosis, prevent liver cancer and reduce the need for liver transplantation". The trial began in January 2001 and more than 1000 patients are enrolled in the long-term study at 10 clinical HALT-C sites. Interim information seems to suggest that the decrease in the rate of fibrosis is higher amongst people who achieve SVR. Those who relapsed or who did not respond to treatment did though achieve some moderate benefit to their liver tissue.
There are other trials in progress involving people with extensive fibrosis or cirrhosis. Interim results from one of the trials showed some reduction in portal hypertension and variceal haemorrhage in patients treated with maintenance peg-interferon and ribavirin.
A few consultants do prescribe 'unauthorised' maintenance therapy in particular cases so it is certainly worth discussing this with your doctor. This is likely to be in people who have advanced fibrosis/cirrhosis and who have had a SVR, but then relapsed and who tolerate the medications reasonably well.
