Important note: Information in this article was accurate in October 2000. The state of the art may have changed since the publication date.
Combination therapy with ribavirin and interferon has improved the chances of recovery from hepatitis C infection compared to therapy with interferon only for some people. The dose of ribavirin used is usually between 1,000 and 1,200 mg/day. In this dose-range some people develop less-than-normal levels of red and white blood cells as ribavirin temporarily suppresses the bone marrow. The decrease in red blood cells can lead to fatigue in some patients.
Researchers in Italy have been studying the effect of ribavirin on red blood cells (RBCs) taken from people who use this drug. According to their results, ribavirin reduces the survival of RBCs. The researchers also found that after taking ribavirin for between two and four weeks, levels of the drug inside RBCs are about 60 times greater than those found in the blood. This large concentration of ribavirin reacts with oxygen in RBCs and undergoes a chemical reaction producing substances that damage or oxidize RBCs. The damaged RBCs are detected by the immune system and are removed from the blood and destroyed. Use of antioxidants such as vitamins C and E by ribavirin users has the potential to reduce damage to RBCs and therefore, some of ribavirin's side effects.
Meanwhile, researchers at ICN pharmaceuticals, the manufacturer of ribavirin, have created a compound very similar to ribavirin called ICN 17261. The good news about this compound is that in experiments on cells and animals it appears to be less toxic than ribavirin. As well, the new compound has anti-viral activity against a range of viruses including hepatitis B and HIV. What makes compound 17261 different from many anti-viral compounds is its interaction with the immune system. It seems that this compound enhances the immune system's antiviral activity. Watch for further news on this compound as it enters clinical trials.
1. De Franceschi L, Fattovich G, Turrini F, et al. Hemolytic anemia induced by ribavirin therapy in patients with chronic hepatitis C virus infection: role of membrane oxidative damage. Hepatology 2000 Apr;31(4):997-1004.
2. Tam RC, Ramasamy K, Bard J, et al. The ribavirin analogue ICN 17261 demonstrated reduced toxicity and antiviral effects with retention of both immunomodulatory activity and reduction of hepatitis-induced serum alanine amino transferase levels. Antimicrob Agents Chemother 2000 May;44(5):1276-83.
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