Severe neutropenia and post-hepatitis C cirrhosis treatment: is interferon dose adaptation at once necessary?

Renou, Christophe; Harafa, Abdelouahid; Bouabdallah, Réda; Dematteï, Chritophe; Cummins, Catherine; Rifflet, H; Müller, P; Ville, Eric; Bertrand, Jean-Jacques; Benderitter, T; Halfon, Philippe

doi:10.1016/s0002-9270(02)04072-8

Cited by 2 publications

(6 citation statements)

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“…1). Of these, six [42–47] were companion publications of other studies [25,28–31]. Through sponsor contact, we received data from a clinical trial evaluating the efficacy of combination therapy with Peg‐IFN plus ribavirin [9].…”

Section: Systematic Review Resultsmentioning

confidence: 99%

“…Through sponsor contact, we received data from a clinical trial evaluating the efficacy of combination therapy with Peg‐IFN plus ribavirin [9]. Overall, 19 unique studies addressed effectiveness [9,27,28,31,32,35,36,38–41] and safety [24–26,29,30,33,34,37]. There was one RCT [32], three retrospective cohort studies [27–29] and 15 case series [9,24–26,30,31,33–41].…”

Section: Systematic Review Resultsmentioning

confidence: 99%

“…Hepatitis C virus (HCV) therapy varied across studies (Table 1). The definition of neutropenia ranged from neutrophil count <0.75 × 10 9 /L [9,24–26,30–32,34,36,37] to <1.0 × 10 9 /L [27–29,33,41]. In two studies, neutropenia was defined as a white blood cell count <3000/μL [38] or <2000/nL [40].…”

Section: Systematic Review Resultsmentioning

confidence: 99%

“…The quality of retrospective cohort studies [27–29] was good. For the case series [9,24–26,30,31,33–41], the median number of items positively identified (i.e. a lower risk of bias) was 9.5/14 (IQR 8–11).…”

Section: Systematic Review Resultsmentioning

confidence: 99%

“…Seven studies [25–30,34] provided data on the risk of infection among patients with neutropenia. The pooled risk of an infection for patients with neutrophil counts <0.75 × 10 9 /L[25,26,30,34] was 1.9% (95% CI: 0.3–9.8). The pooled risk of an infection for patients with neutrophil counts <1.0 × 10 9 /L[26–29,34] was 9.6% (95% CI: 6.6–13.9).…”

Section: Systematic Review Resultsmentioning

confidence: 99%

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Granulocyte colony‐stimulating factor for hepatitis C therapy‐associated neutropenia: systematic review and economic evaluation

Tandon¹,

Doucette

Fassbender

et al. 2011

Journal of Viral Hepatitis

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Hepatitis C virus (HCV) treatment requires maximal adherence to pegylated interferon (Peg-IFN) and ribavirin to achieve a sustained virologic response (SVR). Neutropenia is the most common cause for Peg-IFN dose reduction. Our objectives were to evaluate the effectiveness, safety and cost-effectiveness of granulocyte colony-stimulating factor (G-CSF) versus Peg-IFN dose reduction for HCV therapy-associated neutropenia in treatment naïve adults. We conducted a systematic review to identify controlled trials and observational studies. Study selection, quality assessment and data extraction were completed independently by two investigators. Cost-effectiveness and cost-utility analyses compared G-CSF with dose reduction. Nineteen studies were included. In one trial, the SVR for those receiving G-CSF was 54.5% (95% CI: 34.7-73.1) compared with 26.3% (95% CI: 11.8-48.8) for dose reduction. The remaining studies were case series or retrospective cohorts and provided weak evidence for the relationship between SVR and G-CSF. The risk of adverse events, including infection, associated with G-CSF was low (13.1%; 95% CI: 8.0-20.8) and clinically insignificant. G-CSF had an incremental cost-effectiveness ratio of $41,701 per SVR achieved in genotype 1, and $16,115 per SVR achieved in genotype 2 or 3. Estimates were robust under a variety of resource and intervention scenarios. While administration of G-CSF may enable patients to remain on or resume optimal HCV therapy, there was weak evidence that this improves the likelihood of SVR compared with dose reduction. Adverse effects of G-CSF are mild. The economic evaluation was inconclusive.

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Section: Systematic Review Resultsmentioning

confidence: 99%

Section: Systematic Review Resultsmentioning

confidence: 99%

Section: Systematic Review Resultsmentioning

confidence: 99%

Section: Systematic Review Resultsmentioning

confidence: 99%

Section: Systematic Review Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Granulocyte colony‐stimulating factor for hepatitis C therapy‐associated neutropenia: systematic review and economic evaluation

Tandon¹,

Doucette

Fassbender

et al. 2011

Journal of Viral Hepatitis

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The Impact of Haematopoietic Growth Factors on the Management and Efficacy of Antiviral Treatment in Patients with Hepatitis C Virus

et al. 2005

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Aim To evaluate the benefits of haematopoietic growth factors (HGFs) during the treatment of chronic hepatitis C virus (HCV) infection with severe haematotoxicity. Methods This was a 1-year retrospective study of HCV-positive patients receiving pegylated interferon and ribavirin. Patients received different HGFs, depending on certain criteria: they received erythropoietin (EPO) when their haemoglobin (Hb) levels were less than 10 g/dl and granulocyte colony-stimulating factor (G-CSF) when their neutrophil count was less than 750 cells/mm3. Haematological data, adherence and virological response were analysed and compared according to HGF use. Results In total, 132 patients were studied and 31 (23.5%) required HGF. Under multivariate analysis, baseline Hb levels of less than 13g/dl or a drop in Hb levels of over 2% per week predicted severe anaemia, and a base-line neutrophil count under 2900/mm3 predicted severe neutropaenia. HGF administration restored Hb values and the neutrophil count to above 10 g/dl and 1500 cells/mm3, respectively, in all 31 patients. Adherence to antiviral treatment was achieved in 25% of patients versus 58% of controls without severe haematotoxicity. The primary and sustained virological response did not differ statistically between HGF support and the control group (61% versus 57% and 32% versus 39%, respectively). Conclusion HGF administration counteracts the severe haematological adverse effects which occur during antiviral therapy and maintains the rate of sustained response.

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Severe neutropenia and post-hepatitis C cirrhosis treatment: is interferon dose adaptation at once necessary?

Cited by 2 publications

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Granulocyte colony‐stimulating factor for hepatitis C therapy‐associated neutropenia: systematic review and economic evaluation

Granulocyte colony‐stimulating factor for hepatitis C therapy‐associated neutropenia: systematic review and economic evaluation

The Impact of Haematopoietic Growth Factors on the Management and Efficacy of Antiviral Treatment in Patients with Hepatitis C Virus

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