Information Bulletin #15 - May 2002

This article was taken from www.HIVandHepatitis.com and was written by Brian Boyle. For other articles and information about a wide range of topics visit www.HIVandHepatitis.com on a regular basis.

Procrit (Erythropoietin Alfa) Effectively Improves Anemia Induced by HCV Treatment

Studies have now clearly established that interferon plus ribavirin (Rebetol) is the most effective treatment for chronic hepatitis C virus (HCV) infection. Unfortunately, ribavirin is associated with reversible hemolytic anemia and interferon is associated with bone marrow suppression. These concomitant toxicities may be treatment limiting in some patients and may significantly affect the chance for successful HCV treatment.

Several studies have evaluated the use of recombinant human erythropoietin alfa (rHuEPO) (Procrit and Epogen) for the treatment of ribavirin/interferon-induced anemia in HCV-infected patients. In a letter to the editor of Hepatology, researchers in France reported the results of a study of 13 patients with HCV, one of whom was also HIV-infected, who developed anemia on interferon alfa-2b/ribavirin treatment and who were treated with rHuEPO.

In the study, 9 patients received high dose (6 million units 3 times a week) and 3 patients low-dose (3 million units 3 times a week) interferon alfa-2b and 1 patient received PEG-interferon alfa-2b at 80 µg per week. Ribavirin was given at 1 gram or 1.2 gram per day. When anemia developed, rHuEPO was given at a dose of 4,000 units 2 to 3 times weekly to 11 patients, 8,000 units 3 times weekly to 1 patient, and 10,000 units 3 times weekly to 2 patients.

The baseline median hemoglobin in the 13 patients was 13.3 g/dL and the median hemoglobin nadir on interferon/ribavirin was 10.2 g/dL. On rHuEPO, the hemoglobin increased to a median of 11.5 g/dL and none of the patients on rHuEPO stopped treatment due to anemia. It should be noted, however, that the ribavirin dose was also decreased to 800 mg in 3 patients, to 600 mg in 1 patient, and to 200 mg in 1 patient (who had cirrhosis and HIV). The authors reported that 10 patients had an initial response to interferon/ribavirin treatment, with 4 achieving a sustained response, 5 still under treatment or follow-up, and 1 patient relapsed.

The authors conclude, "in our cohort of patients with chronic hepatitis C treated with interferon/ribavirin combination therapy, rHuEPO was beneficial in the treatment of ribavirin-induced anemia and allowed for the maintenance of a generally efficient ribavirin dosage. "Well-designed clinical trials with larger numbers of patients would be useful to establish the benefit of rHuEPO in this clinical situation as well as the optimal dose and frequency of administration." This report supports the use of rHuEPO in patients with interferon/ribavirin induced anemia. Further studies are underway to evaluate the questions raised by the authors in their conclusion.

Reference: A. Gergely and others. Treatment of ribavirin/interferon-induced anemia with erythropoietin in patients with hepatitis C. Hepatology 2002; 35:1281.

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