HCV treatment-related anemia is associated with higher sustained virologic response rate

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HCV treatment-related anemia is associated with higher sustained virologic response rate

Abstract

BACKGROUND & AIMS: Hepatitis C virus (HCV) treatment is frequently complicated by anemia from ribavirin (RBV)-related hemolysis and peginterferon-alfa (PEG-IFN)- related bone marrow suppression. We investigated the relationships among treatment outcomes, anemia, and its management with RBV dose reduction and/or erythropoiesis-stimulating agents (ESAs).

METHODS: We analyzed data from a trial conducted at 118 United States academic and community centers in treatment-naïve patients with HCV genotype 1. Patients were treated for as many as 48 weeks with 1 of 3 PEG-IFN/RBV regimens. ESAs were given to anemic patients (Hb <10 g/dL) after RBV dose reduction. Sustained virologic responses (SVR) were assessed based on decreases in Hb, anemia, and ESA use.

RESULTS: While patients received treatment, 3023 had their Hb levels measured at least once. A SVR was associated with the magnitude of Hb decrease: >3 g/dL, 43.7%; </=3 g/dL, 29.9% ( P <0.001). Anemia occurred in 865 patients (28.6%); 449 of these (51.9%) used ESAs. In patients with early-onset anemia (</=8 weeks of treatment), ESAs were associated with higher SVR rate (45.0% > 25.9%; P <0.001) and reduced discontinuation of treatment because of adverse events (12.6% < 30.1%, P <0.001). ESAs did not affect SVR or discontinuation rates among patients with late-stage anemia.

CONCLUSION: Among HCV genotype 1-infected patients treated with PEG-IFN/RBV, anemia was associated with higher rates of SVR. The effect of ESAs varied by time to anemia; patients with early-onset anemia had higher rates of SVR with ESA use whereas no effect was observed in those with late-onset anemia. Prospective trials are needed to assess the role of ESAs in HCV treatment.

PMID: 20723545

http://www.ncbi.nlm.nih.gov/pubmed/20723545