Hematologic side effects of interferon and ribavirin therapy.
Pegylated (PEG)-interferon and ribavirin combination therapy are the standard of care for the treatment of chronic hepatitis C and are associated with a high rate of sustained virologic response. However, there is a high incidence of hematologic side effects with this therapeutic regimen. Hematologic side effects are particularly common; bone marrow suppression caused by interferon may result in neutropenia and thrombocytopenia. Ribavirin is directly toxic to red blood cells and is associated with hemolysis, which is usually dose-related but self-limited. Historically, the traditional management of hematologic side effects of interferon therapy has been dose reduction. However, recent studies have shown that response to therapy is strongly influenced by adherence to optimal doses of interferon and particularly ribavirin. Therefore, there is increasing emphasis on the use of growth factors such as filgrastim and erythropoietin to stimulate bone marrow production of erythrocytes and leukocytes to allow patients to receive the optimal doses of interferon and ribavirin. The incidence, magnitude, and possible mechanisms of hematologic complications associated with interferon and ribavirin are described in this review.
Kowdley
Kris V
KV
University of Washington, Seattle, WA 98195, USA. kkowdley@u.washington.edu
D000747:Anemia, Hypochromic / Q000139:chemically induced; D000998:Antiviral Agents / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000627:therapeutic use; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006402:Hematologic Diseases / Q000139:chemically induced* / Q000188:drug therapy; D019698:Hepatitis C, Chronic / Q000188:drug therapy; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects*; D009503:Neutropenia / Q000139:chemically induced; D011092:Polyethylene Glycols / Q000009:adverse effects*; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000139:chemically induced
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; D000069585:Filgrastim; C100416:peginterferon alfa-2a