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Antioxidant Treatment Does Not Substantially Counter the Fall
in Hemoglobin in HCV Patients Treated with Pegylated Interferon
Alfa-2b (Peg-Intron) and Ribavirin
Ribavirin is commonly used in combination with pegylated interferon
alfa to treat patients with chronic hepatitis C (HCV). Ribavirin
can cause hemolysis and a decrease in hemoglobin (Hb) levels
is common. The mechanism of ribavirin-induced hemolysis is
uncertain, but an increased susceptibility of erythrocytes
(RBC) to membrane oxidative damage may play a role.
The aim of the present study was to test whether antioxidant
(AO) treatment would ameliorate the fall in Hb levels in HCV
patients treated with pegylated interferon alfa-2b (Peg-Intron)
and ribavirin.
A randomized, prospective, open-label study was designed to
study the effects of AO treatment (vitamin E, 400 IU BID;
vitamin C, 500 mg BID; S-adenosyl-L-methionine, 400 mg TID)
in HCV patients treated with pegylated interferon alfa-2b
(Peg-Intron) 1.5 mcg/kg QW) and ribavirin (800-1400 mg QD).
Treatment-naive, non-smoking patients with chronic HCV were
divided into two groups: the AO group (n=17) received AO for
a total of 28 w beginning 4 w before antiviral therapy, while
the control group (n=24) received antiviral therapy alone.
This report focuses on measurements made at entry (6 w prior
to antiviral therapy) and at 2, 4 or 12 w of antiviral therapy.
RBC levels of malondialdehyde (MDA, a lipid peroxidation product)
and glutathione (GSH) were also measured.
Results
The control and AO groups were well matched with respect to
age (47 ± 1 vs 49 ± 2), gender (67% vs 59% male), race
(83% vs 94% Caucasian), HCV genotype (79% vs 94% type 1),
and baseline Hb levels (15.2 ± 0.3 vs 15.1 ± 0.3 g/dL).
Antiviral therapy for 12 w resulted in decreases in ALT activity
(-60 ± 10 U/L), platelets (-45 ± 9/mm3), white blood cells
(-2.8 ±
0.4/mm3) and haptoglobin (-20 ± 10 mg/dL), and an increase in retiulocytes
(+1.4 ± 0.4%): none of these effects was significantly changed by
AO.
RBC levels of MDA and GSH were not significantly altered by
either antiviral therapy or AO. In addition, AO did not significantly
ameliorate the fall in Hb levels produced by antiviral therapy
after 2, 4 or 12 w of treatment.
Use of recombinant erythropoietin was similar in both groups
(17% vs 12%).
Conclusion
The authors conclude, “This regimen of AO treatment with vitamin
E, vitamin C and S-adenosyl-L-methionine did not substantially
ameliorate the fall in Hb levels in HCV patients during the
first 12 w of therapy with pegylated interferon alfa-2b and
ribavirin.”
06/07/04
Reference
B R Bacon and others. Antioxidant Treatment Does Not Substantially
Ameliorate the Fall in Hemoglobin in HCV Patients Treated
with Pegylated Interferon Alfa-2b and Ribavirin. Abstract
1150 (poster). Digestive Disease Week. May 15-20, 2004.
New Orleans, LA.
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