Anemia and Hep C treatment. I hope this is right.

Anemia and Hepatitis C Treatment
http://www.hepatitis-central.com/mt/archives/2012/01/anemia_and_hepa.html?eml=hepcen152
January 24, 2012

In opposition to what seems logical, research demonstrates that becoming anemic while on Hepatitis C therapy is not such a bad thing.

by Nicole Cutler, L.Ac.

Hepatitis C treatment rests on the medications pegylated interferon and ribavirin, a combo known to cause anemia. Side effects from this traditional Hepatitis C-fighting duo are often blamed for patients discontinuing therapy and thus being unsuccessful in eliminating the virus from their body. However, researchers claim that anemia, one of the most common Hepatitis C drug side effects, may actually be a good indication that treatment will be successful.

Up until recently, standard therapy for this virus only consisted of pegylated interferon and ribavirin - a combination that was about 50 percent effective in people with the most common Hepatitis C strain: genotype 1. Although likely to dramatically boost the Hepatitis C cure rate, the latest addition of two new drugs to the Hepatitis C arsenal have not been available long enough to reliably quote how effective they are. Nonetheless, the new drugs (Incivek or Victrelis) still must be given in conjunction with pegylated interferon and ribavirin. Thus, anemia from Hepatitis C treatment remains a prominent concern.

About Anemia
Anemia develops from abnormally low levels of red blood cells or hemoglobin. Severe anemia means that a person's blood cannot carry enough oxygen to meet the needs of the body's tissues. Although other substances in the body carry oxygen to the body's tissues, hemoglobin can carry four times as much oxygen throughout the body than water or plasma.

The normal, average life span of a red blood cell is 90 to 120 days. After red blood cells have worn out, the spleen removes them from circulation. To replace those that have been removed, new red blood cells are produced in the bone marrow. Having a healthy amount of oxygen-carrying hemoglobin is a balancing act between making new red blood cells and replacing destroyed red blood cells. When this balance is thrown off kilter, a person can develop anemia.

Anemia from Hepatitis C Drugs
At least 20 percent of people treated with pegylated interferon and ribavirin get drug-induced anemia. The reason is twofold:

1. Ribavirin causes a dosage-dependent, hemolytic anemia, where red blood cells are destroyed faster than the body can make enough new ones to replace them.

2. Interferon can exacerbate anemia by suppressing the bone marrow's production of new red blood cells.

Anemia is one of the most clinically significant side effects of Hepatitis C therapy. Symptoms of anemia include:

• Shortness of breath
• Fatigue
• Pale skin color
• Chills
• Rapid heart rate
• Depression
• Reduced quality of life

If not carefully monitored and treated, hemolytic anemia can lead to jaundice, dark urine, an enlarged spleen and, in severe cases, a heart attack. Because this side effect can be severe, there is a regime for handling anemia while on Hepatitis C treatment. In general, the first approach is to reduce ribavirin dosage. If that is insufficient, an erythropoiesis-stimulating agent (ESA) like Procrit or Epogen is given to boost red blood cell production.

Anemia Is a Good Thing
Between the fear of becoming anemic on treatment, experiencing its discomfort or being skeptical of reducing ribavirin dosage or adding another drug to their regimen, most people on Hepatitis C drugs don't welcome anemia. However, data published in the November 2010 issue of the journal Gastroenterology ought to change that sentiment. According to researchers, Hepatitis C patients who develop anemia during treatment with pegylated interferon plus ribavirin are more likely to achieve a sustained virological response - the elimination of the virus from their body - than those who don't become anemic on the drugs.

Upon analyzing over 3,000 people being treated for Hepatitis C with pegylated interferon and ribavirin, Mark Sulkowski and colleagues found this to be true even when ribavirin reduction or ESA administration was given to reduce anemia. In fact, the rates of achieving a sustained virological response were greater as the severity of the anemia increased.

Because the standard duo of Hepatitis C drugs appears to be more effective in patients who incur anemia as a side effect, plummeting hemoglobin levels doesn't seem so dreadful. Especially since reducing ribavirin dosage or taking an ESA doesn't negatively impact treatment success, there is even more motivation to go on these drugs, be carefully monitored by a physician and complete the prescribed Hepatitis C drug treatment regimen.

[FlGuy]

This article is a generally accepted point of view.   But, "plummeting hemoglobin levels doesn't seem so dreadful"....obviously the author has not been a patient herself.  She is well known for her articles on the subject of HCV, however.

[kmatucson]

I hear you there... I have had anemia for the last 9 weeks and it has been dreadful..  I have 3 weeks left of this nightmare..

[fretboard]

Give me a break, besides she is a licensed acupuncturist not a medical doctor.  That said, I have heard of what she is saying but I don't believe it.  3000 people don't mean didley.  If you're gonna SVR you're gonna SVR and it's not gonna matter whether you suffered through anemia or not.  sheesh!!!  

[kmatucson]

For me, it is wishful thinking if anything..  I can only hope that it is true considering how I have been affected by the anemia.

[OC]

me too, HGB just dropped to 10.8, ribavirin from 1200 to 1000 today.

peace

[can-do-man]

Different drugs and trials, aniema does seem to be a factor.

The development of anemia during protease inhibitor–based triple therapy is interesting because it was predictive of SVR in the SPRINT-2 boceprevir trial: patients who experienced hemoglobin reductions to < 10 g/dL experienced a 72% SVR rate, whereas patients whose hemoglobin levels remained ≥ 10 g/dL experienced a 58% SVR rate (Figure 11).
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when patients who received 12 weeks of telaprevir in the ADVANCE and ILLUMINATE trials were assessed according to the decrease in hemoglobin from baseline, patients with a ≥ 3 g/dL reduction had a markedly higher SVR rate relative to patients with a < 3 g/dL hemoglobin decline, at 76% vs 55%, respectively (Figure 12). These data demonstrate that on-treatment hemoglobin reductions portend a favorable treatment outcome and likely reflect adequate ribavirin exposure.

http://www.clinicaloptions.com/Hepatitis/Treatment%20Updates/Using%20HCV%20PIs/Modules/Case%20Vignettes/Pages/Page%201.aspx  

[kmatucson]

Thanks can-do-man..  I was in the 8's but moved up to the 9's when my gastro reduced my Ribavirin..  I have been putting off Procrit only because I'm so close to the end.. Hopefully I won't drop back into the 8's..

[hrsepwrguy]

I am in a concentration controlled ribavirin trial

http://clinicaltrials.gov/ct2/show/NCT01097395?term=NCT01097395&rank=1

In the ribavirin concentration controlled arm those with an AUC0-12h > 7000 or < 3000 ng*hr/mL will have their doses adjusted to a target AUC0-12h of approximately 5000 ng*hr/mL.

I am also in the concentration controlled arm, I have not been dose reduced or increased, I have reached the targeted level from standard wt based dosing and my lowest HGB has been 11.1