Safety and efficacy of pegylated interferon  -2a and ribavirin for the treatment of hepatitis C in patients with thalassemia

Abstract

Antiviral treatment of hepatitis C virus in thalassemia has raised concerns of ribavirin-induced hemolysis and increased iron loading. This study examined the change in liver iron concentration, transfusion requirement, virological response, and iron-related toxicities after pegylated interferon α-2a/ribavirin treatment in patients with thalassemia. Median transfusions increased by 44%. However, only 29% (4/14) of patients showed an increase of liver iron concentration > 5mg/g dry wt. and overall liver iron remained stable. One of 4 patients with genotype 2 or 3 demonstrated sustained viral response, compared with 50% with genotype 1 (6/12). No patient developed cardiac, liver or endocrine toxicities, although neutropenia occurred in 52%. The molar efficacy of deferoxamine improved with reduction in liver inflammation on biopsy (p=0.001). In conclusion, antiviral treatment is safe if transfusion requirement, iron toxicities and neutropenia are monitored.

Safety and Efficacy of Combination Therapy with Pegylated Interferon Alpha-2a and Ribavirin in Treating Patients with Chronic Hepatitis C and Beta-Thalassaemia Major: A Greek Single-Center Experience

“…Our patient's response rate was comparable to that reported in studies with thalassaemic (33-63%) [3][4][5] and non-thalassaemic patients (50%) [6] , supporting the efficacy of combination therapy in thalassaemic patients. Limited evidence indicates a lower response rate of patients with genotype 3 after 24 weeks of treatment compared with non-thalassaemic subjects, suggesting that 48 weeks of therapy may be needed [5] .…”

Management of chronic viral hepatitis in patients with thalassemia: recommendations from an international panel

“…In the last study, 21 thalassemia adult patients without cirrhosis were treated with Peg-interferon2a and ribavirin for 24 (genotypes 2 and 3) or 48 weeks (genotype 1). 91 SVR was achieved by 1 of 4 patients with genotype 2 or 3 and in 6 of 12 patients with genotype 1. An increase in transfusion requirement of 30% to 40% was observed during the treatment.…”

Treatment of hepatitis C in patients with thalassemia

“…In this issue of the journal, Harmatz et al 20 present a report on the safety and efficacy of the association of pegylated α-2 interferon and ribavirin in patients with thalassemia. Despite a limited study cohort (21 patients of whom only 16 completed the treatment plan), the report clearly confirms the therapeutic efficacy of this association and shows that the expected increase in blood requirement is manageable.…”

“…No patient developed iron-related cardiac, liver or endocrine toxicity although neutropenia was a frequent side effect. The chelation efficiency of deferox- The study by Harmatz et al 20 makes a significant contribution to the debate on the optimal therapy of HCV infection in the setting of thalassemia. A cost/benefit ratio analysis clearly shows the significant advantage of using the best available therapy (pegylated interferon + ribavirin) even in the setting of this special patient population.…”