Epoetin alfa for the Treatment of Combination Therapy-Induced Hemolytic Anemia in Patients Infected With Hepatitis C Virus

Anastasia M. Rivkin, Pharm.D.; Sweta Chawla, Pharm.D.


Pharmacotherapy. 2005;25(6):862-875. 

In This Article

Abstract and Introduction

In the United States, about 2.7 million people are chronically infected with the hepatitis C virus, accounting for nearly 1.8% of the population. The current standard of therapy is a combination of pegylated interferon products and ribavirin. A common adverse effect associated with this therapy is anemia, which is frequently referred to as mixed anemia because of the synergistic contribution of the interferons and ribavirin. The effect of ribavirin on the development of anemia is considered greater than that of interferon. The current standard of practice for treating this adverse effect is reduction of the dosages of both drugs, at prespecified hemoglobin levels. However, recent findings underscore the importance of maintaining adequate dosages of interferon and ribavirin, which may be crucial in achieving an early virologic response and a sustained virologic response in treating patients with hepatitis C infection. Treatment with epoetin alfa for this mixed anemia significantly improved hemoglobin levels and quality of life, and enabled adequate dosages of ribavirin to be maintained. Future studies should address several issues: when to start epoetin alfa treatment, the duration of treatment, the drug's optimal dosage, its effects on end-of-treatment and sustained virologic response rates, and a cost analyses.

The hepatitis C virus (HCV), identified in 1989, is the most common blood-borne infection worl-dwide. The World Health Organization estimates that 170 million people, or 3% of the world's population, are infected with HCV, and 3-4 million are newly infected each year.[1] In the United States, about 2.7 million people have chronic HCV infection, accounting for 1.8% of the population, and approximately 35,000 new HCV infections occur each year.[2,3] The incidence of HCV infection, however, has been on the decline since the 1980s.[2] In many people, HCV infection is not diagnosed; however, the disease is expected to manifest itself in the next decade. The frequency of HCV infection diagnosis is projected to increase 4-fold from 1990 to 2015.[2,3]

Patients infected with HCV are virtually asymptomatic, with the exception of fatigue, which is the most common complaint. In 4-20% of patients, HCV infection progresses to cirrhosis, which occurs an average of 20 years after initial infection.[4,5] About 4% of these patients develop hepatocellular carcinoma, which rarely occurs in the absence of cirrhosis or advanced fibrosis. Currently, HCV is the most common reason for liver transplantation in the United States.[2,3]


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