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Management of Anemia during treatment

Dec 21, 2011 - 1 comments



triple therapy

Thank you to HectorSF for the information below:

Here is an overview of the management of anemia during treatment with the new DAA drugs. It shows how ribavirin dosage reductions and EPO can be used to manage the drop in hemoglobin that results as a combinations of the drugs.

"The New Elements of HCV Care:  Practical Skills to Optimize Protease Inhibitor–Based Therapy"

Program Faculty:

Program Director:
Fred Poordad, MD
Chief of Hepatology
Cedars-Sinai Medical Center
Associate Professor of Medicine
David Geffen School of Medicine
University of California, Los Angeles
Los Angeles, California


Bruce R. Bacon, MD
James F. King, MD, Endowed Chair in Gastroenterology
Professor of Internal Medicine
Division of Gastroenterology and Hepatology
Saint Louis University Liver Center
Saint Louis University School of Medicine
St Louis, Missouri
Graham R. Foster, FRCP, PhD
Professor of Hepatology The Liver Unit
Consultant Hepatologist
Queen Mary, University of London
London, United Kingdom

Paul Y. Kwo, MD
Professor of Medicine
Medical Director of Transplantation
Division of Medicine/Gastroenterology/ Hepatology
Indiana University School of Medicine
Indianapolis, Indiana
*   Optimize therapy with HCV protease inhibitors based on on-treatment factors, such as response to treatment and emergence of adverse effects
*   Provide appropriate care and counsel for patients and their families
Adverse Effect Management: Anemia

Recommendation: Anemia should be managed initially by reducing the RBV dose[1]

Dose reduction of RBV is acceptable

Dose reduction of DAA is not acceptable

Do not discontinue pegIFN/RBV and continue DAA

DAA should not be stopped and then restarted

Monitor closely if Hb falls  12 g/dL

1. Ghany MG, et al. Hepatology. 2011;54:1433-1444.
In the telaprevir clinical trials, both ADVANCE and ILLUMINATE, ribavirin dose reduction was the strategy. The use of epoetin alpha was not allowed for the management of anemia. Here you can see that those patients who had a reduction in the ribavirin dose had identical sustained virologic response rates as those patients who did not have a reduction in the ribavirin dose—76% vs 72% overall.
Boceprevir: SVR in Pts With Hb < 10 g/dL by EPO and/or RBV Dose Reduction

SPRINT-2 (BOC Arms Only)
RBV Dose Reduction - SVR = 78%
EPO                         - SRV = 74%

RESPOND-2 (BOC Arms Only
RBV Dose Reduction - SVR = 83%
EPO                         - SVR = 80%

These are data from the boceprevir clinical trials, both SPRINT-2 and RESPOND-2, comparing patients who utilized epoetin alpha with those who were managed by ribavirin dose reduction, and you can see identical sustained virologic response rates were achieved for patients managed by ribavirin dose reduction alone compared to those patients managed by the use of a hematopoietic growth factor.

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by stormy456, Dec 27, 2011
Thank you thank you thank you.  This is fantastic information to have!

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