Reduction in neutrophil count during hepatitis C treatment: drug toxicity or predictor of good response?

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Dig Dis Sci. 2010 Jul;55(7):2058-62. Epub 2009 Sep 16.

Reduction in neutrophil count during hepatitis C treatment: drug toxicity or

predictor of good response?

Alvarez-Uria G, Day JN, Nasir AJ, SK, Vilar FJ.

Department of Infectious Diseases, North Manchester General Hospital,

Manchester, UK. gerardouria@...

Abstract

BACKGROUND: Bone marrow suppression is a well-recognized toxicity of the

treatment of hepatitis C virus (HCV). Reduction of the peginterferon dose

because of neutropenia is common in clinical practice. However, reduction of

peginterferon dose during the first weeks of HCV treatment is associated with

failure to achieve sustained virological response.

AIMS: The objective of this study is to investigate whether the fall of

neutrophil count during hepatitis C treatment is associated with achieving

sustained virological response.

METHODS: We performed an observational study of patients who completed

peginterferon and ribavirin treatment in an Infectious Diseases Department in

Manchester, UK.

RESULTS: Of the 74 patients included in the analysis, 78% had genotype 2 or 3

hepatitis C and 15% had liver cirrhosis. Sustained virological response was

achieved in 78% of patients. On univariate analysis, factors related to

achieving sustained virological response were younger age, genotype 2 or 3,

baseline neutrophil count, and fall of neutrophil count during treatment.

Multivariate analysis showed baseline neutrophil count >3.5 x 10(3) cells/mm(3)

[odds ratio (OR) 5.7; 95% confidence interval (CI) 1.24-26.3] and a reduction of

neutrophil count >60% (OR 4.5; 95% CI 1.03-19.9) to be independently associated

with achieving sustained virological response. Neutropenia was not associated

with an increased risk of infections.

CONCLUSIONS: In this observational study, higher baseline neutrophil count and

fall of neutrophil count during the treatment of hepatitis C was associated with

achieving sustained virological response. These findings could have important

implications for the monitoring and management of HCV treatment with

peginterferon if they are confirmed in other studies.

PMID: 19757045 [PubMed - indexed for MEDLINE]