title: The prevalence and impact of thrombocytopenia, anaemia and leucopenia on sustained virological response in patients receiving hepatitis C therapy: evidence from a large 'real world' cohort.
abstract: OBJECTIVE
  The aim of the study was to explore the extent of thrombocytopenia (TCP), anaemia and leucopenia in patients with hepatitis C and evaluate how they impact the management of antiviral therapy, the attainment of sustained virological response (SVR), and some therapy-related adverse events.
  
  
  METHODS
  The Scottish Hepatitis C Clinical Database was used in this retrospective study. The prevalence of TCP, anaemia and leucopenia was evaluated. The impact of the three deficiencies on antiviral therapy management, serious adverse events and SVR attainment was assessed in patients who received therapy.
  
  
  RESULTS
  The prevalence of TCP, anaemia and leucopenia was 18.5, 0.9 and 0.2% among 4907 treated patients at baseline, increasing to 72, 25.8 and 5.4% during treatment, respectively. Dose reduction occurred in 29.3% of the patients without TCP; this percentage was higher in those with baseline TCP (53%) and in those who acquired it during treatment (35%). Similar results were found for anaemia and leucopenia. Baseline TCP (odds ratio=0.67, P<0.001) and baseline anaemia (odds ratio=0.43, P=0.03) were identified as risk factors associated with lower SVR rate; acquired TCP and anaemia were not associated with reduced SVR.
  
  
  CONCLUSIONS
  Baseline TCP or anaemia increased the risk of dose cessation. Patients who acquired TCP, anaemia or leucopenia during treatment did not exhibit compromised SVR rates, whereas patients with TCP or anaemia at baseline did. The potential benefit of growth factors in maintaining SVR rate is likely to be confined to those with baseline TCP or anaemia rather than to those who acquire it during therapy, where dose reduction does not appear to reduce the chance of SVR.
authors.affiliation: aDundee Epidemiology and Biostatistics Unit, University of Dundee bDivision of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee cSchool of Health and Life Sciences, Glasgow Caledonian University dHealth Protection Scotland eWalton Liver Clinic, Glasgow Royal Infirmary fGartnavel General Hospital, Glasgow gCrosshouse Hospital, Kilmarnock hDepartment of Hepatology, Stirling Community Hospital, Stirling iAberdeen Royal Infirmary, Aberdeen jRoyal Infirmary Edinburgh, Edinburgh kMonklands Hospital, Lanarkshire, UK.
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
authors.forename: Hamish
authors.initials: H
authors.lastname: Innes
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
authors.forename: David J
authors.initials: DJ
authors.lastname: Goldberg
authors.forename: Samuel
authors.initials: S
authors.lastname: Allen
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Barclay
authors.forename: Peter
authors.initials: P
authors.lastname: Bramley
authors.forename: Raymond
authors.initials: R
authors.lastname: Fox
authors.forename: Andrew
authors.initials: A
authors.lastname: Fraser
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hayes
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kennedy
authors.forename: Peter R
authors.initials: PR
authors.lastname: Mills
authors.forename: John F
authors.initials: JF
authors.lastname: Dillon
mesh_terms: D000328:Adult; D000740:Anemia / Q000175:diagnosis / Q000453:epidemiology*; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016208:Databases, Factual; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007970:Leukopenia / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D013921:Thrombocytopenia / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents