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Heterogeneous Virologic Response Rates to Interferon-Based Therapy in Patients with Chronic Hepatitis C: Who Responds Less Well?

Stefan Zeuzem, MD
[+] Article and Author Information

From Saarland University Hospital, Homburg/Saar, Germany.


Acknowledgments: The author thanks Karen Schneider and Michael von Wagner, MD, for administrative and research assistance with this manuscript.

Grant Support: By the Commission of the European Communities, Specific Research and Technological Development Program Quality of Life and Management of Living Resources (grants QLK2-CT-2000-00836 and QLK2-CT-2002-00954) and by the Bundesministerium für Bildung und Forschung Program Kompetenznetz Hepatitis (grants 01KI0102 7 and 12.2).

Potential Financial Conflicts of Interest:Consultancies, Honoraria, and Grants received: Hoffmann La-Roche, Schering-Plough, Yamanouchi. Dr. Zeuzem has served as a member of international advisory boards and speakers' bureau and as a clinical investigator for Hoffmann La-Roche, Schering Plough, and Yamanouchi.

Requests for Single Reprints: Stefan Zeuzem, MD, Department of Internal Medicine II, Saarland University Hospital, Kirrberger Strasse, 66421 Homburg/Saar, Germany; e-mail, Zeuzem@uniklinik-saarland.de.


Ann Intern Med. 2004;140(5):370-381. doi:10.7326/0003-4819-140-8-200404200-00009
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Internists care for many women who have had abortions and many who will seek abortions in the future. Each year, about 2% of all women of reproductive age have an abortion. Women having abortions tend to be young, white, unmarried, and early in pregnancy. Most abortions are done by suction curettage under local anesthesia in a freestanding clinic. However, medical abortion is growing in popularity as a nonsurgical alternative. The regimen approved by the U.S. Food and Drug Administration specifies mifepristone, 600 mg orally, followed 2 days later by misoprostol, 400 µg orally (within 49 days from last menses). Recent studies have recommended alternative approaches, such as mifepristone, 200 mg orally, followed in 1 to 3 days by misoprostol, 800 µg vaginally (up to 63 days). Medical abortion can be provided by a broader variety of physicians than can surgical abortion. The overall case-fatality rate for abortion is less than 1 death per 100 000 procedures. Infection, hemorrhage, acute hematometra, and retained tissue are among the more common complications. Referral back to the original abortion provider for management is advisable. Overall, induced abortion does not lead to late sequelae, either medical or psychiatric. Of importance, no link exists between induced abortion and later breast cancer. For physicians who are asked to help with a referral, the National Abortion Federation and Planned Parenthood Federation of America have helpful Web sites and networks of high-quality clinics. The cost of abortion (currently about $372 at 10 weeks) has decreased in recent decades. Provision of ongoing contraception and encouragement of emergency contraception can reduce unintended pregnancies and the need for abortion.

Figures

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Figure.
Sustained virologic response rates in patients receiving peginterferon-α2a or interferon and ribavirin.

Top. Sustained virologic response rates in patients treated with peginterferon-α2a (180 µg once weekly) plus ribavirin (1000 or 1200 mg/d), peginterferon-α2a (180 µg once weekly) plus placebo, and interferon (3 MIU 3 times/wk) plus ribavirin (1000 or 1200 mg/d) for 48 weeks . Sustained virologic response rates in patients treated with peginterferon-α2b (1.5 µg/kg once weekly) plus ribavirin (800 mg/d), peginterferon-α2b (1.5 µg/kg once weekly for 4 weeks and then 0.5 µg/kg once weekly for 44 weeks) plus ribavirin (1000 or 1200 mg/d), or interferon (3 MIU 3 times/wk) plus ribavirin (1000 or 1200 mg/d) for 48 weeks(7). HCV = hepatitis C virus.

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