I heard that neutropenia is not associated with increased risk of infection during Hep C treatment. Has anybody got any more info on this?

[mountainair]

I heard that neutropenia is not associated with increased risk of infection during Hep C treatment.  Has anybody got any more info on this?  My treatment coordinator said they can add neupogen, but that there were study results that indicated that low WBC and neutrophils that occurred during tx did not cause infection.  If that's true, why prescribe the neupogen?

Thanks for your input!
Lynda

Current status: on tx Boc Anemia Trial, wk13, UND since wk 6, riba dose reduction, IFN dose reduction, riba dose up again, riba dose reduction again - rollercoaster

[mountainair]

Thanks for the info Mike.  

Since I posted, my ANC went below 500.  I am in the bocep anemia trial in the dose reduction arm so I can't use procrit for the anemia, but my study doc did prescribe neupogen because he said that although the data for increased risk of infection is inconclusive, the consequences of any infection w/ ANC < 500 is well known to be highly dangerous.  Unfortunately, the 38 pages of consent forms which promised that all treatment related medical expenses would be covered by the Study apparently doesn't include neupogen.  My treatment coordinator said "The drug company's position is that the neutropenia can be treated with dose reduction or discontinuation of treatment."  How the heck dose "discontinuing treatment" equal "covering all treatment related medical expenses"?

I am so confused.  My treatment coordinator says I should pay for it myself - she says it costs $300/shot, but my pharmacy said it's more than $1200 for 4 days supply.

[mikesimon]

Risk factors for infection during treatment with peginterferon alfa and ribavirin for chronic hepatitis C.

Roomer R, Hansen BE, Janssen HL, de Knegt RJ.

Departments of Gastroenterology and Hepatology, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Abstract

Neutropenia during treatment with peginterferon alfa and ribavirin for chronic hepatitis C virus (HCV) infection is a common cause of dose reductions of peginterferon alfa. These reductions are performed to prevent bacterial and fungal infections, which are common during HCV treatment and can be attributed to neutropenia. The aims of this study were to investigate the occurrence of infections and their relation to neutropenia and to identify potential risk factors for infections during HCV treatment. In this single-center cohort study, 2,876 visits of 321 patients treated with peginterferon alfa and ribavirin were evaluated for neutropenia, infections, dose reductions, and potential risk factors for infection during HCV treatment. The baseline mean absolute neutrophil count (ANC) was 3,420 cells/μL, and 16 patients had a baseline ANC of <1,500 cells/μL. During treatment, neutropenia, which was defined as ANC <750 cells/μL, was observed in 95 patients (29.7%) and ANC 55 years (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.19-3.56, P = 0.01) and baseline hyperglycemia (OR 2.17, 95% CI 1.15-4.10, P = 0.016) were associated with an increased risk of infection during HCV treatment. Cirrhosis and chronic obstructive pulmonary disease were not risk factors for infection. Conclusion: Bacterial infections during treatment with peginterferon alfa and ribavirin are not associated with neutropenia. Older patients and patients with poorly controlled diabetes mellitus have a greater risk of developing infections during HCV treatment. (HEPATOLOGY 2010).

http://www.ncbi.nlm.nih.gov/pubmed/20830784

[portann]

Hi Lynda,

There are different opinions about low ANC's (the partof WBC's to keep an eye on).

Mine bounced around a lot during tx. My doc let me go to 300 and then it went back up on its own, without neupogen or dose reduction. I never did get sick with a bacterial infection but several here did and took antibiotics.

Neutrophils are your major defense against acute bacterial and some fungal infections and docs have different thresholds for neutropenia caused by interferon. Since you're in a trial, it's to your advantage that you've been offered the neupogen, and now have a choice.

If your neutrophil count falls below 1,000 cells per microliter of blood, risk of infection increases somewhat; if it falls below 500, the risk of infection increases.

And yet there are studies that say that interferon-induced neutropenia does not lead to greater infection.

Aliment Pharmacol Ther. 2009 May 1;29(9):1000-10. Epub 2009 Feb 7:

"CONCLUSIONS: Bacterial infection during peginterferon-based therapy for CHC was associated with comorbidity of cirrhosis, but not with neutropenia, whether at baseline or during treatment. Neutropenic CHC patients might be treated safely with close monitoring."

Infection. 2008 Jun;36(3):250-5. Epub 2008 May 3:


"CONCLUSIONS: During the treatment with pegylated interferons and ribavirin, we did not find a correlation between neutropenia and infections. This result provides a support for the notion that current guidelines for pegylated interferons dose reduction in the treatment of chronic hepatitis C for hematologic toxicity could be overly strict."


Here are some threads voicing different opinions:

http://www.medhelp.org/posts/Hepatitis-C/Need-advice-should-I-say-yes-to-neupogen/show/340785

http://www.medhelp.org/posts/Hepatitis-Social/Question-for-JmJm530---neutropenia/show/42043

Susan

[stg088]

There is an article from 2004 cited in the archives that addresses this. (Look up "neutropenia & infection" in the archives and you'll find it.)  I know I've seen at least one other article that says neutropenia is not associated with increased risk of infection during  Hep C treatment, but I can't put my hands on it right now.