Use of Hematopoietic Growth Factor in the Management of Hematological Side Effects Associated to Antiviral Treatment for HCV Hepatitis

Abstract

Haematological abnormalities are common during combination antiviral therapy for chronic hepatitis C. Although dose reduction or discontinuation can easily treat these side effects, they can adversely affect the efficacy of combination antiviral therapy reducing the likelihood of a sustained viral response (SVR). To avoid potentially diminishing a patient’s chance of response, many physicians have begun using growth factors off-label to manage anaemia and neutropenia in hepatitis C. Haematopoietic growth factors are generally well tolerated and they may be useful for managing haematological side effects of anti-HCV therapy improving patients’ quality of life. To date, the role and benefit of these agents during anti-HCV therapy and their positive impact on SVR have not conclusively determined in the published studies. However, the possibility of a benefit to individual outpatients remains, and an individualized approach is recommended. This review explores the incidence, clinical significance, and management of anaemia, neutropenia and thrombocytopenia associated with combination therapy for HCV infection.

Cardiac toxicity associated with HCV direct antiviral agents

“…Hepatitis C treatment is evolving from interferon-based therapy (IFN) 1–2 to direct antiviral agents (DAA), which have been shown to be highly effective with very few adverse events, 1 , 2 so, unlike interferon, 3 they can be safely administered, without growth factors, even in the presence of thrombocytopenia and anemia, 2 , 4 but may have some dangerous extra-hematological adverse effects, currently little known. In 2015 the Food and Drug Administration and the European Medical Agency added information to the Harvoni (ledipasvir / sofosbuvir) and Sovaldi (sofosbuvir) labels about the serious slowing of the heart rate of amiodarone when taken in combination with another direct acting antiviral for the treatment of hepatitis C infection.…”

Induction with ribavirin in a relapsing patient with chronic HCV hepatitis

“…Particularly, maintaining RBV dose is critical in patients with chronic hepatitis C who are treatment naive or who did not respond to a previous course of antiviral therapy. [8][9][10] Several data indicate that the dose of RBV is very important in preventing relapse. 8 A recent study demonstrated that patients treated with a weight-based RBV had a lower relapse rate than patients receiving fixed doses, especially in patients with high body weight.…”