Introduction A common side effect of treatment with PGI2α and Ribavirin is bone marrow suppression and subsequent neutropaenia. This often results in dose adjustment for fear of rendering patients (pts) more susceptible to serious infection. Our experience is that pts tolerate the neutropaenia without adverse effects and we usually only consider dose reductions if other compelling reasons co-existent. This study was designed to identify the rates of neutropaenia in our treatment group and to determine if they were at greater risk of serious infections.
Methods All pts who started and completed their treatment for Chronic Hepatitis C infection with combination therapy with PGI2α and ribavirin between April 2006 – September 2009 were included in the study. Three pts failed to attend for follow-up and were excluded from the study. As per BSG guidance, pts had their full blood counts monitored weekly for the first month then monthly thereafter while on treatment. The incidence of serious infection was monitored by reviewing clinical notes and hospital admissions.
Results Total number of pts included in the study was 120 (Female=29, Male=91). The genotypes of our patient group were as follows: genotype 1a, 43 pts; genotype 1B, 10 pts; genotype 2a, 2 pts; genotype 2b, 9pts; genotype 3a, 55 pts. Pts with genotype 1 had 48 weeks of treatment and pts with genotype 2 or 3 had 24-week of treatment. Doses were weight adjusted as recommended by national guidelines.
Neutropaenia was classified as a neutrophil count <1.5×109/l and was observed in 52 pts (43%) (Female=17, Male=35). The degree of neutropaenia was further subdivided into; Mild 1.0×109/l–1.5×109/l (35 pts); Moderate 0.5×109/l–1.0×109/l (14 pts) and Severe <0.5×109/l (3 pts).
Dose adjustments were only advised in 3 pts (2 with co-existent neutropaenia and thrombocytopaenia and 1 with recurrent mouth ulcers). Serious infection requiring hospital admission or discontinuation of treatment was not identified in any pts. Of the pts who developed neutropaenia, 46 (88%) had negative PCR at the end of treatment and 40 pts (77%) had sustained virological response (SVR) at 1 year follow-up.
Conclusion Although the incidence of neutropaenia in pts treated with PGI2α plus Ribavirin is relatively common (43% in our series), the risk of resultant serious infection appears remote. Neutropaenia appears to be a more frequent occurrence in treated female pts (59% females cf. 38% males, p<0.05). Dose reduction is such pts developing neutropaenia as suggested by current guidance appears to be unnecessary and may diminish the likelihood of viral eradication and SVR.
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