Epoetin alfa treatment for acute anaemia during interferon plus ribavirin combination therapy for chronic hepatitis C

被引:16
作者
Bräu, N
机构
[1] Vet Affairs Med Ctr, Dept Med, Div Infect Dis, Infect Dis Sect 111F, Bronx, NY 10468 USA
[2] CUNY Mt Sinai Sch Med, New York, NY 10029 USA
关键词
anaemia; epoetin alfa; haemoglobin; hepatitis C virus; interferon; quality of life; ribavirin;
D O I
10.1111/j.1365-2893.2004.00506.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Infection with the hepatitis C virus (HCV) remains chronic in 75% of infected individuals. in whom it can cause liver inflammation and progressive fibrosis leading to cirrhosis in 20% of patients. A sustained viral response (SVR) to HCV therapy. i.e. undetectable plasma HCV RNA 6 months after the end of treatment. leads to permanent eradication of the virus in 98.3%, of patients. The current treatment of choice is combination therapy with pegylated interferon alfa (PEG-IFN alfa), 2a or 2b. and ribavirin (RBV), which achieves an SVR in 54-56%, of patients. In patients with HCV genotype 1. RBV doses of 1000-1200 mg/day are associated with a higher SVR than 800 mg/day (51 vs 40%). However, RBM also causes dose-dependent reversible haemolytic anaemia that, in combination with the myelosuppressive effects of PEG-IFN. results in it mean drop in haemoglobin (Hb) level of 3.7 g/dL within 4 weeks. Conventionally, this acute anaemia has been managed with RBV dose reductions. However, this may result in a decreased SVR rate. Alternatively, this anaemia can be managed with administration of epoetin alfa at 40 000 IU once weekly. In a randomized placebo-controlled trial, treatment with epoetin alfa has been shown to raise Hb levels and maintain RBV doses. Furthermore, the increase in Hb level was associated with improved quality of life. Anaemia in patients treated with interferon plus RBV combination therapy can be managed effectively and safety with once weekly epoetin alfa without sacrificing optimal dosing of RBV.
引用
收藏
页码:191 / 197
页数:7
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