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Can PEG help nonresponders?

Dr. Rodriquez:

My husband is a 57 year old male diagnosed in 1989 with nonA, nonB hepatitis. in 1995 he did a year of mono therapy on Schering-Plough's intron A. In 1996 he did a year + on the protocol for ribavirin and intron A. He went from 28.4 million viral load to 1.2 million viral load where he stayed. He was on the combo for close to 3 years when the dr. added Amantadine. After 3 months, the Amantadine was dropped. After long years of research and insistence, I convinced the dr. to switch my husband from Schering-Ploughs intron, to 15 mcg's of infergen(by Amgen). He has been on this treatment for over one year and his viral load is now 24,000. His Dr. (a gastro), applied for the pegylated interferon, but his insurance turned it down saying that there was no proof that the pegylated would have any effect on a non-responder.

As you are a researcher, I was wondering if you could provide me with some data that would refute this HMO's medical directors statement. As patients, we are not allowed to speak with Dr. Nathan, the Medical Director for the Health Plan of Nevada. Dr. Rodriquez, I beg you, if there is any research out there at all that says this would be beneficial to my husband, please send it to me.

Over a year on the 15 mikes of infergen has been very hard on my husband and over 5 years of interferon treatment of various kinds has taken it's toll on him. He has diabetes now, hypertension, losing hearing, vision, hair of course, goes through mood swings and is not the man I married 26 years ago. He becomes both verbally and physically abusive. This is hard on me as I am wheelchair bound,(post-polio following a 2nd bout of bulbar polio 9 years ago). His PC has just prescribed paxil for him and I pray that it works. However, I am more interested in getting him on the peg in order to lessen the side effects he has been dealing with for well over five years now. Si no puedes entender esto e-mail, por favor, e-mail me and si es possible, yo pienso que es possible que mi Espanol es mas o menos correcto. Gracias por todo...Que Dios lo bendiga.

-- C.

Dr. Rodriquez writes--

There are no reports yet in the literature of non-responders trials with peg-interferons. There are preliminary reports at medical meetings that at week 24, up to 40% may respond to Pegasys-RBV. Also some early reports with Peg-Intron are promising. The combo of Pegasys-RBV-amantadine also is very promising in early data. The most important issue in your husbands case at this moment will be to assess his hepatic status. This may need another liver biopsy. Patients that receive interferon treatment (and your husband has received more that any case I have seen), will have histological improvement even if they do not have viral response. You need to discuss clearly with your physician, the possible benefits now as compared to the side effects. MR