Normal erythropoietin response in chronic hepatitis C patients with ribavirin-induced anaemia.
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.
Durante Mangoni
Emanuele
E
Cattedra e Divisione di Medicina Interna ed Epatologia, Seconda Università di Napoli, Italy. emanuele.durante@unina2.it
Marrone
Aldo
A
Saviano
Donatella
D
Del Vecchio
Carmen
C
Utili
Riccardo
R
Ruggiero
Giuseppe
G
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
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D004921:Erythropoietin; D012254:Ribavirin