QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Santos, A. E D. Articles by Yoshida, E. M Search for Related Content PubMed PubMed Citation Articles by Santos, A. E D. Articles by Yoshida, E. M

HEMATOLOGY

Use of Hematopoietic Growth Factors as Adjuvant Therapy for Anemia and Neutropenia in the Treatment of Hepatitis C

Oncology Drug Information Specialist, British Columbia Cancer Agency, Vancouver, British Columbia, Canada

Nilufar Partovi, PharmD FCSHP

Clinical Professor, Faculty of Pharmaceutical Sciences, University of British Columbia; Clinical Coordinator and Pharmacotherapeutic Specialist, Department of Pharmacy, Vancouver General Hospital, Vancouver

Jo-Ann E Ford, RN MSN

Associate Director, British Columbia Hepatitis Program, Vancouver

Eric M Yoshida, MD MHSc FRCP(C) FACP FACP

Associate Professor of Medicine; Head, Division of Gastroenterology, University of British Columbia

Reprints: Dr. Dar Santos, BC Cancer Agency, 600-750 W. Broadway, Vancouver, BC V5Z 1H1, Canada, fax 604/708-2026, adarsantos{at}bccancer.bc.ca

OBJECTIVE: To review the hematologic adverse effects of hepatitis C virus (HCV) therapy and adjuvant treatment with epoetin alfa and granulocyte colony-stimulating factor (ie, filgrastim).

DATA SOURCES: Medical literature indexed in MEDLINE (1966-January 2007) and EMBASE (1980-January 2007) was searched, and published conference abstracts were reviewed.

STUDY SELECTION AND DATA EXTRACTION: Peer-reviewed articles and relevant conference abstracts regarding the use of epoetin alfa and granulocyte colony-stimulating factor were reviewed.

DATA SYNTHESIS: Ribavirin induces a dose-dependent hemolytic anemia. Studies using epoetin alfa 40 000 units subcutaneously once weekly have demonstrated efficacy in maintaining hemoglobin, ribavirin dose, and quality of life scores, but clear benefit shown with sustained virologic response (SVR) is lacking. The hemoglobin threshold for initiation of epoetin alfa used in studies may not adequately reflect values used in clinical practice. Treatment-related neutropenia is caused primarily by interferon or peginterferon. Few studies have investigated the impact of granulocyte or granulocyte-macrophage colony-stimulating factor derivatives on neutropenia. Results of dose maintenance evaluation vary, and studies reporting data on SVR showed no effect from growth factor therapy. The frequency of bacterial infections was not reported.

CONCLUSIONS: The role and benefit of hematopoietic growth factors in HCV therapy have not been conclusively determined to date. However, the possibility of a benefit to individual patients seen on an outpatient basis remains, and an individualized treatment approach is recommended.

Key Words: epoetin, filgrastim, hepatitis C

Published Online, February 13, 2007. www.theannals.com, DOI 10.1345/aph.1H169

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-07-008-H01

This article has been cited by other articles:

				J. J. Kiser Trends in the Treatment of Chronic Hepatitis C Virus Infection Journal of Pharmacy Practice, August 1, 2009; 22(4): 405 - 418. [Abstract] [PDF]