Early decline of hemoglobin correlates with progression of ribavirin-induced hemolytic anemia during interferon plus ribavirin combination therapy in patients with chronic hepatitis C.
BACKGROUND
The aim of this study was to examine the factors correlated with the progression of ribavirin-induced hemolytic anemia in patients with chronic hepatitis C treated by interferon and ribavirin combination therapy.


METHODS
This study was conducted on 505 patients by the Osaka Liver Disease Study Group. A decline of hemoglobin (Hb) concentration by 2 g/dl at the end of 2 weeks from the start of the treatment ("2 by 2" standard) was adopted as a predictive factor for progression to severe anemia. The ribavirin apparent clearance (CL/F) was also examined.


RESULTS
Of 482 patients whose Hb value was more than 12 g/dl before the treatment, 68 patients (14%) had to discontinue ribavirin owing to severe anemia. Patients in the "2 by 2"-positive group (Hb decline over 2 g/dl) and the group with lower CL/F were significantly more likely to discontinue ribavirin owing to severe anemia. Discontinuation was more common among patients aged 60 years or older than for those under 60 years old (21% vs. 9%, P < 0.001). Among patients aged 60 years or older, only the "2 by 2" standard was significantly associated with the discontinuance of ribavirin owing to severe anemia in a multivariate analysis (odds ratio, 4.18; P < 0.001).


CONCLUSIONS
The "2 by 2" standard of Hb decline can be used to identify patients likely to develop severe anemia. The early reduction of ribavirin can help prevent progression to severe anemia, thus allowing ribavirin therapy to be completed even in older patients.
Oze
Tsugiko
T
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan.
Hiramatsu
Naoki
N
Kurashige
Nao
N
Tsuda
Natsuko
N
Yakushijin
Takayuki
T
Kanto
Tatsuya
T
Takehara
Tetsuo
T
Kasahara
Akinori
A
Kato
Michio
M
Yoshihara
Harumasa
H
Katayama
Kazuhiro
K
Kubota
Shinji
S
Hijioka
Taizo
T
Ishibashi
Kazunobu
K
Oshita
Masahide
M
Hagiwara
Hideki
H
Haruna
Yoshimichi
Y
Mita
Eiji
E
Tamura
Shinji
S
Hayashi
Norio
N
D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000097:blood / Q000139:chemically induced*; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004279:DNA, Viral / Q000032:analysis; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000172:deficiency*; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
D000998:Antiviral Agents; D004279:DNA, Viral; D006454:Hemoglobins; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D012254:Ribavirin