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Epoetin alfa allows continuation of antiviral therapy in anemic HCV-infected patients
  NEW YORK (Reuters Health) - Once-weekly epoetin alfa improves treatment-related anemia and may facilitate maintenance of ribavirin dosing in patients infected with hepatitis C virus (HCV), according to a report by a multicenter group. The impact on outcomes remains to be seen.
Standard treatment of HCV infection includes interferon alfa in combination with ribavirin, both of which are associated with decreased hemoglobin levels, the authors note in the November issue of The American Journal of Gastroenterology. When anemia results, ribavirin doses are usually reduced to levels that have been associated with a lower likelihood of sustained virological responses.
Dr. Douglas T. Dieterich from Mount Sinai School of Medicine, New York and colleagues evaluated the efficacy of once-weekly doses of epoetin alfa in alleviating anemia and minimizing ribavirin dose reductions in 64 anemic, HCV-infected patients.
After 16 weeks, patients assigned to epoetin alfa treatment had higher mean hemoglobin levels (13.8 g/dL) than did patients assigned to standard care (11.4 g/dL), the authors report. The difference was even greater for patients who actually received epoetin alfa (14.2 g/dL) than for those who actually received standard care (11.2 g/dL).
Mean ribavirin doses at week 16 were also higher among patients assigned to epoetin alfa treatment (891 mg/day) than among patients assigned to standard care (779 mg/day), the report indicates. Moreover, 83% of patients receiving epoetin alfa maintained daily ribavirin doses of 800 mg or more, compared with only 54% of patients receiving standard care.
Improvements in quality of life measures were greater in the epoetin alfa treatment group than in the standard care group, the investigators report, and epoetin alfa treatment was well tolerated.
Virological and biochemical laboratory measures did not differ significantly between the treatment groups.
"Based on the results of this study," the authors conclude, "epoetin alfa seems to be promising for the treatment of anemia in HCV-infected patients receiving ribavirin/interferon combination therapy. Further research is warranted to investigate the potential impact of epoetin alfa therapy on outcomes, including quality of life and sustained viral response."
"We believe these agents can enhance ribavirin dosage, which might be closely linked to response rates," write Dr. Anouk Dev and associates from Duke University Medical Center, Durham, North Carolina in a related editorial. "However, although this preliminary study has answered some of our questions, many more remain unanswered and will hopefully provide the impetus for carefully planned, larger scale studies in the future."
Am J Gastroenterol 2003;98:2491-2499,2344-2347.
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