Hepatitis C Treatment-Related Anemia Assoc w-Higher SVR Rate

Hep C virus treatment-related anemia is associated with higher sustained virologic response rate

Hepatitis C virus treatment is frequently complicated by anemia from ribavirin-related hemolysis and peginterferon-alfa-related bone marrow suppression.
Dr Mark Sulkowski and colleagues investigated the relationships among treatment outcomes, anemia, and their management with ribavirin dose reduction and/or erythropoiesis-stimulating agents.

The research team analyzed data from a trial conducted at 118 United States academic and community centers in treatment-naïve patients with Hepatitis C genotype 1.
Patients were treated for as many as 48 weeks with 1 of 3 peginterferon-alfa/ribavirin regimens.

Anemia occurred in 29% of patients
Gastroenterology

Erythropoiesis-stimulating agents were permitted for anemic patients after ribavirin dose reduction.

Sustained virologic responses were assessed based on decreases in hemoglobin, anemia, and erythropoiesis-stimulating agents use.

While patients received treatment, 3023 had their hemoglobin levels measured at least once.
The research team found that a sustained virological response was associated with the magnitude of hemoglobin decrease.

Anemia occurred in 29% of patients, and 52% used erythropoiesis-stimulating agents.
In patients with early-onset anemia, erythropoiesis-stimulating agents were associated with higher sustained virological response rate, and reduced discontinuation of treatment because of adverse events.

The researchers observed that erythropoiesis-stimulating agents did not affect sustained virological response rates or discontinuation rates among patients with late-stage anemia.
Dr Sulkowski's team commented, "Among Hepatitis C genotype 1-infected patients treated with peginterferon-alfa/ribavirin, anemia was associated with higher rates of sustained virological response."

"The effect of erythropoiesis-stimulating agents varied by time to anemia."
"Patients with early-onset anemia had higher rates of sustained virologic response with erythropoiesis-stimulating agents use, whereas no effect was observed in those with late-onset anemia."

"Prospective trials are needed to assess the role of erythropoiesis-stimulating agent use in Hepatitis C treatment."

Gastroenterol 2010: 139(5): 1602-1105 November 2010