Nisan 2013
Ribavirine bagli anemi yüksek viral yanitlarla iliskili midir?
Is there a relationship between ribavirin-induced anemia and viral response rates during HCV therapy?
- Ana Sayfa
- Sayılar
- Nisan 2013
- Ribavirine bagli anemi yüksek viral yanitlarla iliskili midir?...
Özet
Giris ve Amaç:Pegile interferon ve ribavirin kombinasyonu hepatit C için standart tedavidir; kalici viral yanit oranlari genotip 1 için 42-52% olarak bildirilmistir. Ribavirin nedeniyle hemolitik anemi önemli bir yan etkisidir. Ribavirin dozunun azaltilmasi antiviral tedaviye yanitin azalmasina yol açar. Ribavirin kaynakli aneminin virolojik sonuçlari etkileyip etkilemedigini arastirmak için retrospektif bir çalisma planladik.Gereç ve Yöntem:Kronik hepatit C genotip 1 ile enfekte olan ve 48 hafta süreyle pegile interferon ve ribavirin verilen 164 hasta çalismaya dahil edildi. Ilaç kaynakli hemoglobin düsüsü tedavi öncesi degerden >3 gr/ dl düsüs olarak tanimlandi. 8,5-10 gr/dl hafif anemi, <8,5 gr/dl siddetli anemi olarak tanimlandi. Tedavi sirasinda hemoglobin <10 gr/dl düzeyine düserse ribavirin dozu 200 mg/gün azaltildi, <8,5 gr/dl düzeyine düserse iki hafta durduruldu. Yanit oranlari (ilk 12 hafta ve 13-48 haftalar sirasinda) ile yukarida belirtilen durumlarin varligi arasindaki iliski arastirildi. Bulgular:Hastalarin yas ortalamasi 53 yil idi. Ilk 12 haftada anemi 55 hastada (% 33.5) gözlendi. Bu grupla anemi olmayan di-ger grup arasinda viral yanitlar açisindan anlamli bir farklilik (n = 55, %33,5) saptanmadi (sirasiyla p=0.1, 0,385, 0,456, 0,730). Aneminin siddetine göre de gruplar arasinda viral yanitlar açisindan istatistiksel olarak anlamli bir fark saptanmadi. Eritropoietin hiç kullanilmadi, yerine ribavirin dozu azaltildi veya kesildi. Sonuç: Yukaridaki bulgular, ribavirin dozu azaltilmadan (ek eritropoietin tedavisi ile) tedavinin tamamlanmasi halinde daha yüksek virolojik yanitlara ulasilabilecegi konusunda uyaricidir.
Abstract
Background and Aims:Pegylated interferon and ribavirin combination is the standard therapy for hepatitis C; sustained viral response rates are reported as 42-52% for genotype 1. Hemolytic anemia due to ribavirin is an important side effect. Ribavirin dose reduction leads to reduction in the response to antiviral therapy. We planned a retrospective study to investigate whether anemia due to ribavirin affects the virologic outcomes. Materials and Methods: 164 patients infected with chronic hepatitis C genotype 1 and given pegylated interferon and ribavirin for a 48-week period were included. Drug-induced hemoglobin decrease was defined as >3 g/dl below the pretreatment value. 8.5-10 g/dl was defined as mild and <8.5 g/dl as severe anemia. Ribavirin dose was reduced by 200 mg/day if hemoglobin <10 g/dl or was ceased for two weeks if hemoglobin was <8.5. Later, if hemoglobin increased to above 8.5 g/dl in this period, ribavirin was restarted. We investigated the relationship between the presence of the abovementioned status (during the first 12 weeks and weeks 13-48) and the response rates. Results: The mean age was 53 years. In the first 12 weeks, anemia was observed in 55 patients (33.5%). There were no differences between this group (n=55, 33.5%) and the group without anemia (n=109, 66.5%) in virologic responses (p=0.1, 0.385, 0.456, 0.730, for rapid, early, end of treatment, and sustained viral responses, respectively). There were also no statistically significant differences regarding virologic responses between the groups in relation to the severity of anemia. Erythropoietin was never used; rather, the ribavirin dose was reduced or stopped. Conclusions:We are encouraged by our results suggesting that if ribavirin can be completed without dose reduction (with additional erythropoietin therapy), it may lead to even higher virologic responses.
