Managing the hematologic side effects of antiviral therapy for chronic hepatitis C: anemia, neutropenia, and thrombocytopenia.
Hematologic abnormalities such as anemia, neutropenia, and thrombocytopenia are common during combination therapy with pegylated (or standard) interferon and ribavirin for chronic hepatitis C. Ribavirin-induced hemolytic anemia is a common cause of dose reduction or discontinuation. Bone marrow suppression also contributes to the anemia and is the predominant mechanism for interferon-induced neutropenia and thrombocytopenia. Although dose reduction or discontinuation of combination therapy can reverse these abnormalities, they may reduce virologic response. Hematopoietic growth factors may provide a useful alternative for managing these hematologic side effects without reducing the optimal dose of the combination antiviral regimen. Treatment of anemia also may improve patients' health-related quality of life and their adherence to combination antiviral therapy. The impact of growth factors on sustained virologic response and their cost-effectiveness in patients with chronic hepatitis C need further assessment.
Ong
Janus P
JP
Center for Liver Diseases, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
Younossi
Zobair M
ZM
D000740:Anemia / Q000139:chemically induced* / Q000188:drug therapy*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D000068256:Darbepoetin alfa; D004359:Drug Therapy, Combination; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000009:adverse effects; D007372:Interferons / Q000008:administration & dosage / Q000009:adverse effects*; D017370:Interleukin-11 / Q000008:administration & dosage / Q000627:therapeutic use*; D009503:Neutropenia / Q000139:chemically induced* / Q000188:drug therapy*; D010349:Patient Compliance; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D012254:Ribavirin / Q000008:administration & dosage / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000188:drug therapy*
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D017370:Interleukin-11; D011994:Recombinant Proteins; D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor; D000068256:Darbepoetin alfa; D011092:Polyethylene Glycols; D012254:Ribavirin; D000068817:Epoetin Alfa; D007372:Interferons; C417083:peginterferon alfa-2b; C105308:oprelvekin; D000069585:Filgrastim; C100416:peginterferon alfa-2a