Ribavirin Levels and Haemoglobin Decline in Early Virological Responders and Non-Responders to Hepatitis C Virus Combination Therapy

Abstract

Therapeutic drug monitoring of ribavirin has been claimed to predict virological response and/or haematological side effects in patients with chronic hepatitis C undergoing peginterferon/ribavirin combination treatment. In the present study, steady-state ribavirin levels were retrospectively analyzed in serum samples from patients at week 12 of combination therapy with peginterferon alpha-2a or alpha-2b and ribavirin. Patients were classified as early virological responders on the basis of undetectable HCV-RNA or HCV-RNA drop ≧2 log from baseline at week 12. The mean ribavirin level was not different between early virological responders (2.3 ± 0.1 µg/ml, n = 45) and early virological non-responders (2.0 ± 0.2 µg/ml, n = 10). There was no correlation between ribavirin levels at week 12 and early virological response. In patients with early virological response, haemoglobin (Hb) levels were found to be decreased by 18% on average from the basal values; however, in only 2 patients Hb levels declined below 100 g/l. There was a moderate negative correlation between ribavirin levels and Hb levels at week 12 (R = –0.50, p < 0.001); however, ribavirin levels did not correlate with relative or absolute decline in Hb as compared to basal levels or with ribavirin dose per kilogram body weight. In addition, a significant negative correlation between ribavirin levels and glomerular filtration rate was found (R = –0.31, p < 0.05). Based on our results, monitoring of ribavirin serum levels at week 12 of HCV combination therapy does not appear to predict early virological response or reductions in Hb levels. Further research is needed to assess their diagnostic value at other time points of peginterferon/ribavirin combination treatment and/or in patients with renal insufficiency.

Role of Pegylated Interferon-α-2a and Ribavirin Concentrations in Sustained Viral Response in HCV/HIV-Coinfected Patients

“…High Rbv concentrations were associated with the occurrence of anemia but did not correlate with viral responses, in either the univariate or the multivariate analysis. Rbv dose and exposure have been associated with SVR for genotypes 1 and 4, 10 , 23 , 24 but this relationship has not been unanimously confirmed, with several studies suggesting that lower Rbv doses may be equally effective 25 , 26 , 27 , 28 . Although Rbv is indispensable in the current treatment for HCV, neither the susceptibilities of the different HCV genotypes to Rbv nor the relationship between plasma and intracellular (the true effect compartment) concentrations of Rbv are known.…”

Ribavirin therapeutic drug monitoring: why, when and how?

“…In contrast to SVR, the relationship between ribavirin concentration and EVR remains controversial. In HCV‐mono‐infected patients, no significant correlation was found between serum ribavirin trough concentration and EVR at week 4 [17] or week 12 [18], while ribavirin plasma exposure after the first dose was significantly linked to the rapid virological response (RVR), and to a lesser extent, the EVR [15].…”

Ribavirin in chronic hepatitis C: past and future

“…In a retrospective study, Donnerer et al found no correlation between ribavirin levels at week 12 and EVR [43]. By contrast, recent findings in HCV-HIV-coinfected patients suggested that a high ribavirin concentration could improve the EVR rate [44].…”