Severe anemia risk remains in TVR-based triple therapy for HCV

Ogawa E. J Hepitol. 2013;doi:10.1016/j.jhep.2013.05.017.

  • September 20, 2013

Patients with HCV who were treated with telaprevir in combination with pegylated interferon alfa-2b and ribavirin therapy remained at a significantly increased risk for severe anemia, recent study results suggest.

Researchers examined the risk for severe anemia in 292 patients (mean age, 62 years) infected with HCV genotype 1 who were assigned telaprevir (TVR) in combination with pegylated interferon alfa-2b (Peg-IFN a-2b) and ribavirin (RBV) for 12 weeks. Severe anemia was defined as hemaglobin (Hb) levels lower than 85 g/L.

Results indicated that 34.6% of patients developed severe anemia during antiviral treatment. The onset of severe anemia most frequently occurred between weeks 8 and 12. Multivariate analysis showed that predictors of anemia included baseline Hb <135 g/L (HR=2.53; 95% CI, 1.43-4.51), an estimated glomerular filtration rate <80 ml/min/1.73 m2 (HR=1.83; 95% CI, 1.07-3.16) and the presence of the inosine triphosphatase CC genotype (ITPA CC; HR=2.91; 95% CI, 1.44-6.32).

For patients with the ITPA CC genotype (77.7%), predictors of severe anemia included Hb levels at week 2 (HR=0.96; 95% CI, 0.93-0.98) and the initial 4 weeks of weight-adjusted TVR treatment (HR=1.05; 95% CI, 1.01-1.10).

"[C]hronic hepatitis C patients treated with TVR in combination with [Peg-IFN a-2b] and RBV are at high risk of developing severe anemia, therefore, an intense monitoring program for all patients should be followed," the researchers concluded." Our finding [is] that ITPA polymorphism (rs1127354) is effective for the prediction of the development of severe anemia and will be helpful in the management of patients undergoing TVR-based triple therapy."

Disclosure: The researchers report no relevant financial disclosures.