Role of epoetin alfa in maintaining ribavirin dose

The Current standard of care for the treatment of hepatitis C virus (HCV) infection is the use of interferon alfa-2a or alfa-2b, standard (IFN) or pegylated (PEG-IFN), in combination with ribavirin (RBV) [1]. PEG-IFN is now the most commonly used IFN formulation because of its less frequent dosing requirement and overall improved sustained virologic response (SVR) rates. Patient adherence to these combination treatment regimens, particularly patients who have genotype 1 infection, appears to be important for viral eradication and achievement of an SVR [2]. Hematologic toxicities (neutropenia, thrombocytopenia, anemia) associated with anti-HCV therapy are a major reason for dose reduction, although they require discontinuation of therapy only rarely (3% of patients; Fig. 1) [3-5]. In recent large, randomized trials of PEG-IFN/RBV therapy, neutropenia, thrombocytopenia, and anemia resulted in dose reductions in up to 21%, 4%. and 23% of patients, respectively [3,4]. In these trials dose reductions because of side effects occurred in 37% to 42% of patients (including those caused by laboratory abnormalities [hematologic side effects], which occurred in 25-27% of patients) [3-5]. Because maintaining IFN or PEG-IFN and RBV doses is important to achieving SVR and hematologic side effects cause a large proportion of dose reductions, monitoring of hematologic side effects and appropriate management might play a substantial role in obtaining a Successful treatment outcome.