A national French survey on the use of growth factors as adjuvant treatment of chronic hepatitis C.
We conducted a national retrospective survey on hospital practitioners to evaluate the magnitude of erythropoietin (EPO) or granulocyte colony-stimulating factor (G-CSF) prescriptions in patients treated for chronic hepatitis C. Four hundred seventy-one questionnaires were sent, and 274 practitioners (58.2%) responded. Forty-six percent of practitioners used EPO, and 31% used G-CSF. The total number of HCV-infected patients receiving antiviral therapy per year was estimated at 6,630 patients, of whom 8.8% and 4% received EPO and G-CSF, respectively. EPO-beta was the main EPO molecule prescribed at a median dose of 30,000 IU/wk (range: 2,000-80,000). The indications for prescribing EPO varied greatly, including "fragile patients" (34%), "low" Hb level (8-11 g/dL) (19%), "rapid decline" in Hb level (2-5 g/dL during the first month of therapy) (12%), and symptomatic anemic patients (7%). G-CSF was mainly prescribed for a "low" level of neutrophils ranging from 400 to 750 neutrophils/mm3. In multivariate analysis, independent predictors of EPO and G-CSF prescription were age of practitioner less than 45 years (EPO: OR = 1.96, P = 0.03; G-CSF: OR = 2.27, P = 0.004), practice in university hospital (EPO: OR = 5.89, P < 0.0001; G-CSF: OR = 2.39, P = 0.003), and the high number of CHC treated/year (EPO: OR = 6.18, P < 0.0001; G-CSF: OR = 2.58, P = 0.002).


CONCLUSIONS
Our survey reveals an important rate of EPO and G-CSF prescriptions but with considerable disparity in the schedule of injections, the molecules used, and above all the indications. The suitable role of EPO and G-CSF as complements to HCV therapy urgently needs to be clarified.
Thévenot
Thierry
T
Service d'Hépatologie et de Soins Intensifs Digestifs, Hôpital Jean Minjoz, 25000 Besançon, France. tthevenot@chu-besancon.fr
Cadranel
Jean-François
JF
Di Martino
Vincent
V
Pariente
Alexandre
A
Causse
Xavier
X
Renou
Christophe
C
Hagege
Hervé
H
Denis
Jacques
J
Lunel-Fabiani
Françoise
F
D000328:Adult; D000367:Age Factors; D017024:Chemotherapy, Adjuvant; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005602:France; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006306:Health Surveys; D016298:Hematopoietic Cell Growth Factors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
D016298:Hematopoietic Cell Growth Factors; D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor