Growth factors during HCV therapy may be “cost-effective”, but are they “effective”?

Muir, Maya; McHutchison, John G.

doi:10.1002/hep.21426

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…Despite these limitations, a recent analysis suggested that the use of hematopoietic growth factors, especially darbepoetin, was a cost effective intervention during PEG-IFN/RBV treatment of HCV monoinfected patients 32, 35 . However, this analysis assumed that growth factor supplementation resulted in improved SVR rates, which has not yet been conclusively determined 36 .…”

Section: Discussionmentioning

confidence: 98%

Randomized Trial Comparing Dose Reduction and Growth Factor Supplementation for Management of Hematological Side Effects in HIV/Hepatitis C Virus Patients Receiving Pegylated-Interferon and Ribavirin

Talal

Liu

Zeremski

et al. 2011

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction Pegylated-interferon (PEG-IFN) and ribavirin (RBV), current standard treatment for hepatitis C virus (HCV) infection, is frequently associated with neutropenia and anemia, leading to high treatment discontinuation rates in HIV/HCV coinfected patients. Our objective was to compare the effectiveness of intervening with hematologic growth factors versus dose reductions of standard HCV therapy for the management of treatment-induced hematologic disorders. Methods Ninety-two HIV/HCV coinfected, therapy-naive subjects received PEG-IFN alfa-2b 1.5 μg/kg/wk and RBV 13 ± 2 mg/kg/day for up to 48 weeks. Before treatment initiation, subjects were randomized to subsequently receive growth factors, recombinant human erythropoietin (rHuEPO) and/or granulocyte-colony stimulating factor (G-CSF), or dose reduction (RBV and/or PEG-IFN) for anemia and neutropenia management, respectively. We analyzed the ability of each management strategy to control anemia and neutropenia and the percentage of subjects who achieved a successful treatment outcome among subjects according to the different management strategies. Results During treatment, 43 subjects developed anemia (HuEPO, n=24; dose reduction, n=19) while 25 subjects developed neutropenia (G-CSF, n=10; dose reduction, n=15). Following the intervention, the increase in both hemoglobin and absolute neutrophil counts also did not differ between the two side effect management strategies. Sustained response percentages were similar comparing anemic and neutropenic subjects regardless of management strategy (anemia: rHuEPO, 29% versus dose reduction, 21%, p=0.92; neutropenia: G-CSF, 40% versus dose reduction, 20%, p=0.46). Conclusions Growth factor supplementation and dose reduction do not appear to differ as management strategies for anemia and neutropenia in HIV/HCV co-infected individuals treated with PEG-IFN/RBV.

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Section: Discussionmentioning

confidence: 98%

Randomized Trial Comparing Dose Reduction and Growth Factor Supplementation for Management of Hematological Side Effects in HIV/Hepatitis C Virus Patients Receiving Pegylated-Interferon and Ribavirin

Talal

Liu

Zeremski

et al. 2011

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…In addition, based on recent observations from other patient populations, such as persons with cancer, the FDA issued a black box warning stating that the aggressive use of erythropoiesis‐stimulating agents (ESAs) to raise Hb levels to ≥12 g/dL has been associated with “serious and life‐threatening side‐effects and/or death” (http://www.fda.gov/cder/drug/infopage/RHE/default.htm). These revised recommendations regarding target Hb levels for erythropoietic growth factors should also be observed when used to treat ribavirin‐induced anemia (see Figure 3; Muir & McHutchison, 2006).…”

Section: Safety Profile Of Ribavirinmentioning

confidence: 99%

Role of the nurse practitioner in the management of patients with chronic hepatitis C

Olson

Jacobson

2011

Journal of the American Academy of Nurse Practitioners

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“…This is not a unique problem. [21][22][23] The use of consensus interferon and pretreatment screening have reduced the costs of effective therapy. Consensus interferon is 40% to 50% cheaper than pegylated interferons.…”

Section: No Body Piercing or Tattoos For 6 Monthsmentioning

confidence: 99%

New Opportunities for the Management and Therapy of Hepatitis C in Correctional Settings

Martin¹,

Hostetter²,

Hagan³

2010

Am J Public Health

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Hepatitis C in prison populations is now a major public health problem, and large numbers of correctional facilities have no comprehensive management program, often because of formidable projected costs and tightening budget constraints. The North Dakota Department of Corrections and Rehabilitation has operated a management and therapy program since 2002 using consensus interferon and ribavirin with 45% cost savings. The program has provided excellent sustained viral responses: 54.2% for genotype 1 hepatitis C, 75% for genotypes 2 and 3, and 63.6% overall.

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Growth factors during HCV therapy may be “cost-effective”, but are they “effective”?

Cited by 8 publications

References 19 publications

Randomized Trial Comparing Dose Reduction and Growth Factor Supplementation for Management of Hematological Side Effects in HIV/Hepatitis C Virus Patients Receiving Pegylated-Interferon and Ribavirin

Randomized Trial Comparing Dose Reduction and Growth Factor Supplementation for Management of Hematological Side Effects in HIV/Hepatitis C Virus Patients Receiving Pegylated-Interferon and Ribavirin

Role of the nurse practitioner in the management of patients with chronic hepatitis C

New Opportunities for the Management and Therapy of Hepatitis C in Correctional Settings

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