title: Normal erythropoietin response in chronic hepatitis C patients with ribavirin-induced anaemia.
abstract: BACKGROUND
  Ribavirin administration for chronic hepatitis C is associated with the development of haemolytic anaemia, which affects treatment efficacy and tolerability. In a pilot study, the exogenous administration of erythropoietin has been shown to be beneficial, reducing the rate of ribavirin dose reduction. How ribavirin administration affects normal erythropoietin production has not been determined.
  
  
  OBJECTIVE
  To investigate the endogenous erythropoietin response in hepatitis C patients with ribavirin-induced anaemia.
  
  
  METHODS
  Serum erythropoietin was measured before and during interferon-ribavirin treatment in 18 HCV-positive subjects. Mathematical analysis and modelling were applied to compare the degree of erythropoietin increase in HCV-positive and in otherwise healthy anaemic patients, and estimate the endogenous excess erythropoietin production in response to ribavirin-induced anaemia.
  
  
  RESULTS
  Erythropoietin concentration increased significantly in response to anaemia caused by ribavirin. The physiological erythropoietin response to the ribavirin-induced anaemia was as adequate in HCV-positive subjects as it is in anaemic subjects without liver disease. The recommended exogenous erythropoietin dose appears three-times greater than the endogenous erythropoietin boost.
  
  
  CONCLUSIONS
  Chronic liver damage by HCV does not affect the physiological erythropoietin response to ribavirin-induced anaemia. While the rationale for erythropoietin treatment of ribavirin-induced anaemia is not straightforward, the currently recommended dosing regimen should be reassessed.
authors.affiliation: Cattedra e Divisione di Medicina Interna ed Epatologia, Seconda Università di Napoli, Italy. emanuele.durante@unina2.it
authors.forename: Emanuele
authors.initials: E
authors.lastname: Durante Mangoni
authors.forename: Aldo
authors.initials: A
authors.lastname: Marrone
authors.forename: Donatella
authors.initials: D
authors.lastname: Saviano
authors.forename: Carmen
authors.initials: C
authors.lastname: Del Vecchio
authors.forename: Riccardo
authors.initials: R
authors.lastname: Utili
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ruggiero
mesh_terms: D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000139:chemically induced*; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D004921:Erythropoietin; D012254:Ribavirin