Safety and efficacy of pegylated interferon alpha-2a and ribavirin for the treatment of hepatitis C in patients with thalassemia
Paul Harmatz, Maureen M Jonas, Janet L Kwiatkowski, Elizabeth C Wright, Roland Fischer, Elliott Vichinsky, Patricia J Giardina, Ellis J Neufeld, John Porter, Nancy Olivieri, Thalassemia Clinical Research Network, Ellis Neufeld, Melody Cunningham, Jennifer Braunstein, Alan R Cohen, Janet L Kwiatkowski, Catherine S Manno, Marie Martin, Debra Hillman, Alexis Thompson, Dena Haddad, Elliott Vichinsky, Sylvia Singer, Nancy Sweeters, Dru Foote, Eun-Ha Pang, Laura Quill, Nancy Olivieri, Jennifer Breaton, Jennifer Yang, John Porter, Cindy Bhagwandin, Patricia J Giardina, Jeffrey E Mait, Dorothy Kleinert, Elizabeth Wright, Eric Macklin, Ellen McCarthy, Charles Peterson, Paul Harmatz, Maureen M Jonas, Janet L Kwiatkowski, Elizabeth C Wright, Roland Fischer, Elliott Vichinsky, Patricia J Giardina, Ellis J Neufeld, John Porter, Nancy Olivieri, Thalassemia Clinical Research Network, Ellis Neufeld, Melody Cunningham, Jennifer Braunstein, Alan R Cohen, Janet L Kwiatkowski, Catherine S Manno, Marie Martin, Debra Hillman, Alexis Thompson, Dena Haddad, Elliott Vichinsky, Sylvia Singer, Nancy Sweeters, Dru Foote, Eun-Ha Pang, Laura Quill, Nancy Olivieri, Jennifer Breaton, Jennifer Yang, John Porter, Cindy Bhagwandin, Patricia J Giardina, Jeffrey E Mait, Dorothy Kleinert, Elizabeth Wright, Eric Macklin, Ellen McCarthy, Charles Peterson
Abstract
Antiviral treatment of hepatitis C virus in thalassemia has raised concerns of ribavirin-induced hemolysis and increased iron loading. This study examined the change in liver iron concentration, transfusion requirement, virological response, and iron-related toxicities after pegylated interferon alpha-2a/ribavirin treatment in patients with thalassemia. Median transfusions increased by 44%. However, only 29% (4/14) of patients showed an increase of liver iron concentration > 5mg/g dry wt. and overall liver iron remained stable. One of 4 patients with genotype 2 or 3 demonstrated sustained viral response, compared with 50% with genotype 1 (6/12). No patient developed cardiac, liver or endocrine toxicities, although neutropenia occurred in 52%. The molar efficacy of deferoxamine improved with reduction in liver inflammation on biopsy (p=0.001). In conclusion, antiviral treatment is safe if transfusion requirement, iron toxicities and neutropenia are monitored.
Source: PubMed