title: Predictors of changes in hemoglobin levels in patients with chronic hepatitis C treated with ribavirin plus pegylated interferon-α.
abstract: BACKGROUND
  Combination therapy with pegylated interferon (pegIFN)-α and ribavirin (RBV) for chronic hepatitis C virus (HCV) infection is associated with reduction in hemoglobin (Hb) concentrations and anemia. The aim of this study was to evaluate the magnitude and frequency of change in Hb and determine the predictive risk factors for Hb decrease during this therapy.
  
  
  METHODS
  We enrolled 308 patients with chronic HCV infection who were receiving weekly subcutaneous pegIFN injection in combination with body weight-based oral RBV for 24 weeks. Clinical and virological characteristics were used for studying the predictors of decrease in Hb.
  
  
  RESULTS
  The majority (95%) of patients showed reduction in Hb concentration of at least 1 g/dL during pegIFN and RBV combination therapy. The mean and median maximal decrease in Hb level of the study patients was 3.9 g/dL (range -0.3 to 8.2 g/dL; interquartile range 2.8-5.0 g/dL). Of all patients, 49.4% showed a reduction in Hb level of more than 4 g/dL; a higher number of male patients than female patients showed an Hb decrease of >4 g/dL. Multivariate analysis of our data showed that older age, high baseline Hb concentration, high HCV RNA viral load, low estimated glomerular filtration rate (eGFR), and low platelet count were independent predictors of significant decline in Hb levels.
  
  
  CONCLUSIONS
  Patients with low eGFR before antiviral therapy may have an increased risk of RBV-related anemia and should be closely monitored. Clinician should consider the potential risk of significant reduction in Hb level according to eGFR while deciding the RBV dose.
authors.affiliation: Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Hu
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.forename: Chih-Lang
authors.initials: CL
authors.lastname: Lin
authors.forename: Hui-Ching
authors.initials: HC
authors.lastname: Tien
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Kuo
authors.forename: Cheng-Hung
authors.initials: CH
authors.lastname: Chien
authors.forename: Cho-Li
authors.initials: CL
authors.lastname: Yen
authors.forename: Chun-Yen
authors.initials: CY
authors.lastname: Lin
authors.forename: Rong-Nan
authors.initials: RN
authors.lastname: Chien
mesh_terms: D000284:Administration, Oral; D000740:Anemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D000998:Antiviral Agents / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006454:Hemoglobins / Q000378:metabolism*; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D007279:Injections, Subcutaneous; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D012367:RNA, Viral / Q000032:analysis; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage*; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D006454:Hemoglobins; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a