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Suppression
of Blood Cell Formation during Chronic Hepatitis C Therapy
with Different Interferon Alfa Mono- and Combination Therapy
Regimens
Suppression of the formation of blood cells is a serious adverse
event that results from the use of interferon
alfa in chronic hepatitis C. Researchers at the University
of Vienna evaluated the effects of four different IFN/IFN
plus ribavirin treatment regimens on hematopoiesis (blood
cell formation).
Hematopoiesis
was studied in 133 patients with chronic hepatitis C receiving
IFN-alfa-2b
(Intron A) alone (group A) or
in combination with ribavirin (group B), pegylated
IFN-alfa-2a (Pegasys) alone (group C), or pegylated
IFN-alfa-2b (group D) in combination with ribavirin.
Results
· At
week 4, hemoglobin
levels were diminished in all groups receiving
combination therapy.
· In
the monotherapy group, hemoglobin decreased slightly after
eight weeks.
· In
all groups, hemoglobin remained diminished throughout therapy.
· In
all patients, leucocytes (while blood cells) decreased after
four weeks and remained low during treatment.
· Platelets (peripheral platelet count (PPC))
were decreased in all groups after four weeks and remained
below baseline levels during therapy in group A, C, and D
whereas in group B PPC recovered early and reached baseline
levels at week 16 of therapy.
· Concomitantly
with the decreases in hemoglobin and PPC, erythropoietin
increased in all groups receiving combination therapy and
thrombopoietin in all groups.
· Patients
treated with pegylated IFN-alfa-2a (Pegasys) and those who
received pegylated IFN-alfa-2b (PegIntron) combination therapy
differed only in leucopoiesis, whereas erythropoiesis and
thrombopoiesis were comparable.
In
closing the authors conclude:
· IFN-alfa-based
therapies are associated with a decrease in all three hematopoietic
lineages, irrespective of the type of therapy used.
· The
stronger suppressive effect of pegylated IFN-alfa-2a on leucopoiesis
could be due to a dose effect.
· Overall,
concentrations of endogenous hematopoietic
growth factors are increased but can only partially
alleviate hematotoxicity.
· Potential
uses of exogenous hematopoietic growth factors and their impact
on the virological response need to be explored.
Department of Internal Medicine IV,
Division of Gastroenterology and Hepatology, University of
Vienna, Wahringergurtel 18-20, A-1090 Vienna, Austria.
07/15/05
Reference
M
Schmidt and others. Gut 54(7):1014-1020. July 2005.
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