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272 ERYTHROPOIETIN IMPROVES ANEMIA AND FACILITATES OPTIMAL USE OF PEGYLATED INTERFERON AND RIBAVIRIN IN PATIENTS WITH CHRONIC HEPATITIS C P Tan, C Ghent, M Levstik BACKGROUND: Recent trials have demonstrated that 54% of hepatitis-C (HCV) infected patients receiving standard interferon (IFN) plus ribavirin (RBV) therapy experience a drop in hemoglobin of at least 3g/L. Moreover, at 8 weeks of standard therapy, only 54% of patients maintained a RBV dosage of at least 800mg/day.
AIM: To determine the role of erythropoietin (EPO) in preventing anemia and minimizing RBV dose reductions in patients treated with pegylated interferon/RBV for chronic hepatitis-C.
METHODS: A retrospective review was performed on 28 HCV patients treated with pegylated interferon/RBV at a tertiary care centre. Information regarding viral load, genotype, weight, hemoglobin (Hb), white blood count (WBC), platelet count (PLT), and IFN and RBV dosages pre and post-onset of EPO was extracted. All transplanted patients were excluded from the study.
RESULTS: A total of 28 charts were reviewed. During the first four weeks of pegylated IFN/RBV therapy, a mean decrease in Hb of 28.0g/L occurred. EPO was initiated at a mean drop in Hb of 42.9g/L after a mean of 13 weeks of antiviral therapy. After 8 weeks of EPO therapy, Hb increased by a mean of 17g/L. RBV dose reductions occurred in 21% of patients, with 25 of 28 patients (89%) maintaining RBV dosage of at least 800mg/day. Thirteen of 28 patients (46%) experienced negative sequelae related to antiviral therapy (time off work and/or antidepressant prescribed). However, RBV was not prematurely discontinued in any of the 28 patients reviewed. In addition, WBC and PLT dropped by a mean of 2.3 and 40.5 at 4 weeks of antiviral therapy, respectively.
CONCLUSIONS: Achieving target dosage and duration of pegylated IFN plus RBV therapy in the treatment of chronic hepatitis-C is often limited by anemia and the need for RBV dosage reductions. This study demonstrates that EPO can treat anemia and facilitate the maintenance of RBV dosing, thus allowing optimization of HCV therapy.