Epoetin alfa allows continuation of antiviral therapy in anemic HCV-infected
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
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,
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.