title: Clinical recommendations for the use of recombinant human erythropoietin in patients with hepatitis C virus being treated with ribavirin.
abstract: Today, combination antiviral therapy with pegylated interferon-alpha and ribavirin (RBV) allows many patients infected with hepatitis C virus (HCV) to achieve a sustained virological response, which is equivalent to cure. Data also support the clinical benefit of combination antiviral therapy in patients coinfected with HCV and HIV, and in patients who have received a liver transplant. Antiviral therapy with pegylated interferon-alpha and RBV is, however, associated with a high incidence and significant magnitude of anemia. This anemia may have several mechanisms, including bone marrow suppression and hemolysis. In addition, patients coinfected with HIV may have both pre-existing and RBV-associated anemia. Management of anemia in patients with HCV through RBV dose reduction or treatment discontinuation may compromise the effectiveness of treatment, because studies have demonstrated that treatment adherence or maintenance of antiviral therapy dose is an important predictor of sustained virological response. Anemia associated with combination antiviral therapy in patients with HCV is frequently associated with an inadequate or blunted endogenous erythropoietin response. Accumulating evidence now supports the use of recombinant human erythropoietin (rHuEpo) to manage anemia in these patients, with the objective of maintaining the RBV dose, but clinical standards are lacking. The present article reviews the data relevant to the use of rHuEpo in this patient population and proposes a set of clinical practice standards to assist clinicians in selecting patients for rHuEpo and in implementing rHuEpo therapy effectively.
authors.affiliation: Toronto General Hospital, University of Toronto, Toronto, Canada. morris.sherman@uhn.on.ca
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
authors.forename: Lawrence
authors.initials: L
authors.lastname: Cohen
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Cooper
authors.forename: Magdy
authors.initials: M
authors.lastname: Elkashab
authors.forename: Victor
authors.initials: V
authors.lastname: Feinman
authors.forename: David
authors.initials: D
authors.lastname: Fletcher
authors.forename: Nigel
authors.initials: N
authors.lastname: Girgrah
authors.forename: Jenny
authors.initials: J
authors.lastname: Heathcote
authors.forename: Mark
authors.initials: M
authors.lastname: Levstik
authors.forename: William B
authors.initials: WB
authors.lastname: McNaull
authors.forename: David
authors.initials: D
authors.lastname: Wong
authors.forename: Florence
authors.initials: F
authors.lastname: Wong
authors.forename: Colina
authors.initials: C
authors.lastname: Yim
mesh_terms: D000465:Algorithms; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015897:Comorbidity; D004359:Drug Therapy, Combination; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D015658:HIV Infections / Q000453:epidemiology; D006397:Hematinics / Q000627:therapeutic use*; D006526:Hepatitis C / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D016031:Liver Transplantation; D011788:Quality of Life; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D006397:Hematinics; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D004921:Erythropoietin; D012254:Ribavirin; D000068817:Epoetin Alfa