Role of growth factors and thrombopoietic agents in the treatment of chronic hepatitis C

Abstract

Advanced liver disease and interferon-based treatment are both associated with varying degrees of cytopenia in patients with chronic hepatitis C. Growth factors to increase hemoglobin and neutrophils are commonly used in clinical practice, despite the absence of data to indicate benefits in terms of sustained viral response. Thrombocytopenia is observed frequently, is multi-factorial in etiology, and may result in significant limitations on interventional and therapeutic options. A small-molecule thrombopoietin mimetic, eltrombo-pag, has demonstrated a dose-response associated increase in platelet count in a phase 2 study, allowing initiation and completion of a 12-week course of peginterferon plus ribavirin in 36%, 53%, and 65% of patients receiving 30 mg, 50 mg, or 75 mg of eltrombopag daily, respectively, compared with 6% in the placebo arm. Phase 3 studies are currently evaluating whether initiating and maintaining antiviral therapy with eltrombopag will lead to an increase in sustained virologic response in chronic hepatitis C infection.

Genome-wide association study of interferon-related cytopenia in chronic hepatitis C patients

“…Identifying patients at greatest risk for such complications would be clinically useful for selecting patients for therapy, as well as planning the frequency of monitoring and likely need for growth factor support on treatment. Patients with advanced hepatic fibrosis are at highest risk [5], but bone marrow suppression remains prevalent in patients with early stage fibrosis and there is a need for more accurate biomarkers. A genetic biomarker for predicting risk of IFN-related bone marrow suppression would be particularly useful as a pre-treatment test.…”