Source: Digestion  |  Posted 8 years ago

Maintenance of ribavirin (RBV) dose with epoetin alfa may improve adherence and as well as sustained virologic response (SVR) in patients with hepatitis C virus infection (HCV), according to the author of a review article.

"Treatment for hepatitis C virus (HCV) infection includes RBV plus interferon alfa (IFN-alpha) or pegylated IFN, a combination associated with anaemia that may require RBV dose reduction or discontinuation," notes Mark S. Sulkowski, MD, with Johns Hopkins University, Baltimore, Maryland, United States.

Recent research has indicated that about 16% of HIV-infected patients are coinfected with HCV. IFN-RBV-associated anaemia is even more profound among coinfected individuals, who have a high prevalence of pretreatment anaemia and may also be taking other medications that cause anaemia, the author notes.

According to Dr. Sulkowski, administering epoetin alfa to HCV-infected patients with IFN-RBV-related anaemia can significantly increase haemoglobin levels. In addition, it allows for continuation of significantly higher RBV doses compared with patients treated with RBV dose reduction alone.

"Emerging data suggest that a key element of successful combination therapy with IFN-RBV is the ability of the patient to maintain adequate doses of both drugs throughout the designated treatment period," Dr. Sulkowski states in his report.

In addition, data derived from large, randomised clinical trials, indicate that RBV dose and patient adherence are important factors in achieving SVR, "particularly among 'difficult-to-treat' patients, such as those infected with HCV genotype 1 and those with high baseline levels of HCV RNA."

According to the author, preliminary data suggest that epoetin alfa can increase Hb level, improve quality of life, and decrease the need for RBV dose reduction in patients who develop IFN-RBV-related anaemia.

"Studies are currently under way to assess whether these improvements lead to enhanced patient adherence and increased hepatitis C response rates among HCV-infected patients with and without HIV coinfection," he notes.