Low dose ribavirin for treatment of HCV infected thalassemia major patients; new indications for combination therapy

Tabatabaei, S.V. and Alavian, S.M. and Keshvari, M. and Behnava, B. and Miri, S.M. and Elizee, P.K. and Zamani, F. and Kafiabad, S.A. and Gharehbaghian, A. and Hajibeigy, B. and Lankarani, K.B. (2012) Low dose ribavirin for treatment of HCV infected thalassemia major patients; new indications for combination therapy. Hepatitis Monthly, 12 (6). pp. 90-99.

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Abstract

Background: Treatment guidelines contraindicate ribavirin for treatment of hepatitis C virus (HCV) infection in thalassemia major patients. Nevertheless, the current evidence suggests that ribavirin might be tolerated by these patients. Objectives: Despite this evidence, low dose ribavirin combination therapy has not been compared with peg interferon monotherapy in these patients so far. Patients and Methods: Two hundred eighty thalassemia patients with detectable HCVRNA PCR (� 50 IU/mL) and liver histology consistent with chronic HCV infection were self-assigned to receive peg interferon alfa-2a (n = 81) monotherapy or its combination therapy with ribavirin, 600-800 mg QD, according to hemoglobin levels (n = 199). Treatment experienced patients were eligible for this study. Results: Sustained virological response (SVR) was significantly higher in patients who received ribavirin (51 vs. 38 P = 0.02). In multivariate regression, OR of ribavirin for prediction of SVR was 2.2 (95 CI 1.24-3.91). The SVR was significantly higher in the ribavirin group in subgroups of patients with more than 24 years of age, elevated ALT, ferritin < 2006 ng/mL, previous treatment failure, genotype 1, positive history of splenectomy, fibrosis score of 0-4 HAI and viral load < 600,000 IU/mL. Treatment discontinuations due to the safety concerns were comparable between the treatment groups (6.5 and 8 ). Furthermore, transfusion intervals were almost halved in patients who received low dose ribavirin. Conclusions: According to the present study, adult thalassemia patients with HCV infection can be treated successfully with low dose ribavirin. Hence, we strongly advise combination therapy in thalassemia patients with aforementioned clinical characteristics. Moreover, ribavirin does not seem to be beneficial in thalassemia patients below 18 years of age. © 2012 Kowsar Corp. All rights reserved.

Item Type: Article
Additional Information: cited By 11
Uncontrolled Keywords: alanine aminotransferase; ferritin; hemoglobin; peginterferon alpha2a; ribavirin; virus RNA, adolescent; adult; age; alopecia; arthralgia; article; child; chill; clinical trial; controlled study; coughing; death; depression; diarrhea; dizziness; drug dose reduction; drug efficacy; drug safety; drug withdrawal; dry skin; fatigue; female; fever; fibrosis; flu like syndrome; genotype; genotyping technique; headache; hepatitis C; histology; human tissue; insomnia; irritability; lethargy; liver biopsy; low drug dose; major clinical study; male; myalgia; nausea; neutropenia; open study; patient compliance; prospective study; pruritus; rash; school child; side effect; splenectomy; thalassemia major; thrombocytopenia; treatment failure; virus load; weight reduction
Subjects: WC Communicable Diseases
QY Clinical Pathology
Divisions: School of Rehabilitation Sciences
Depositing User: parto mrs bakhtminoo
Date Deposited: 26 Jan 2019 10:11
Last Modified: 26 Jan 2019 10:11
URI: http://eprints.iums.ac.ir/id/eprint/9896

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