Review article: optimizing SVR and management of the haematological side effects of peginterferon/ribavirin antiviral therapy for HCV – the role of epoetin, G‐CSF and novel agents

Abstract

Aliment Pharmacol Ther 31, 929–937 Summary Background Chronic hepatitis C is one of the leading causes for chronic liver disease globally. The past two decades have seen many advances in hepatitis C treatment. Despite these advances, side effects of treatment are common. Haematological complications of treatment can result in treatment cessation and suboptimal results. Recent data have suggested a role for epoetin/granulocyte colony stimulating factor (G‐CSF) in optimizing sustained virological response (SVR). Aim To investigate the nature, frequency and management of haematological side effects in the treatment of chronic hepatitis C infection. Methods The terms hepatitis C, hepatitis C virus (HCV), treatment, side effects, interferon, peginterferon, ribavirin, anaemia, haemoglobin, neutropenia, thrombocytopenia, haematological, growth factor, erythropoietin and G‐CSF were searched on MEDLINE for the period 1991–2009. References from selected articles were also included. Results Haematological side effects such as anaemia, neutropenia and thrombocytopenia are frequent in anti‐HCV treatment. The off‐label use of haematological growth factors is common and effective. Conclusions Erythropoietic agents are effective in treating anaemia, preventing ribavirin dose reduction, improving patients’ quality of life, but the effect on SVR is not fully elucidated. G‐CSF is effective in raising absolute neutrophil count; however, neutropenic HCV‐infected patients on combination treatment may not experience increased bacterial infections. Eltrombopag, a new oral thrombopoietin mimetic, may allow combination treatment in patients with thrombocytopenia.

Hepatitis C: Understanding factors that influence the physicians' treatment decisions

“…Discussing the final results of Enable 1, a phase 3, multicentre study, the authors concluded that eltrombopag increases platelet counts in these patients to levels which could enable 95% of them to initiate antiviral HCV therapy, and subsequently to maintain antiviral dosage and achieve a SVR. Similar findings are reported by McHutchison et al (2007) for patients with TCP due to HCV-related cirrhosis, and by Stasi et al (2009) and Mac Nicholas and Norris (2010). 10 However, Bussel and Pinheiro (2011) reported challenges with adherence to eltrombopag treatment due to administration-related issues (it must be taken every day apart from specific meals containing high levels of calcium).…”

Partial Splenic Embolization Facilitates the Adherence to Peginterferon in Chronic Hepatitis C with Thrombocytopenia

“…However, in this study, PSE prior to starting the combined therapy did not progress the adherence to ribavirin. Recently, erythropoietic agents are shown to be effective in treating anemia, preventing ribavirin dose reduction, and improving patients' quality of life during the combined therapy (25). Hereafter, eryhthropoietic agents will be expected to improve and prevent anemia during the combined therapy.…”

Association of ITPA polymorphisms rs6051702/rs1127354 instead of rs7270101/rs1127354 as predictor of ribavirin-associated anemia in chronic hepatitis C treated patients

“…Repeatedly, individual RBV dose and pharmacokinetic (Pk) exposure have been found to be consistent determinants of treatment-associated anemia, and recommendations on dose reduction have been released in order to mitigate the impact of RBV on the severity of anemia (Aguilar Marucco et al, 2008;D'Avolio et al, 2012a;Kubota et al;Lindahl et al, 2004;Mac Nicholas and Norris;McHutchison et al, 2006).…”