Subject(s)
Antibodies, Bacterial/analysis , Choriocarcinoma/diagnosis , Gastric Mucosa/pathology , Helicobacter pylori/immunology , Stomach Neoplasms/diagnosis , Biopsy , Choriocarcinoma/surgery , Female , Gastrectomy , Helicobacter Infections , Humans , Middle Aged , Stomach Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The aim of this study was to examine the factors correlated with the progression of ribavirin-induced hemolytic anemia in patients with chronic hepatitis C treated by interferon and ribavirin combination therapy. METHODS: This study was conducted on 505 patients by the Osaka Liver Disease Study Group. A decline of hemoglobin (Hb) concentration by 2 g/dl at the end of 2 weeks from the start of the treatment ("2 by 2" standard) was adopted as a predictive factor for progression to severe anemia. The ribavirin apparent clearance (CL/F) was also examined. RESULTS: Of 482 patients whose Hb value was more than 12 g/dl before the treatment, 68 patients (14%) had to discontinue ribavirin owing to severe anemia. Patients in the "2 by 2"-positive group (Hb decline over 2 g/dl) and the group with lower CL/F were significantly more likely to discontinue ribavirin owing to severe anemia. Discontinuation was more common among patients aged 60 years or older than for those under 60 years old (21% vs. 9%, P < 0.001). Among patients aged 60 years or older, only the "2 by 2" standard was significantly associated with the discontinuance of ribavirin owing to severe anemia in a multivariate analysis (odds ratio, 4.18; P < 0.001). CONCLUSIONS: The "2 by 2" standard of Hb decline can be used to identify patients likely to develop severe anemia. The early reduction of ribavirin can help prevent progression to severe anemia, thus allowing ribavirin therapy to be completed even in older patients.
Subject(s)
Anemia, Hemolytic/chemically induced , Antiviral Agents/adverse effects , Hemoglobins/deficiency , Hepatitis C, Chronic/drug therapy , Interferon-alpha/therapeutic use , Ribavirin/adverse effects , Adult , Aged , Anemia, Hemolytic/blood , Antiviral Agents/therapeutic use , DNA, Viral/analysis , Disease Progression , Drug Therapy, Combination , Female , Follow-Up Studies , Hepacivirus/genetics , Hepatitis C, Chronic/blood , Hepatitis C, Chronic/virology , Humans , Interferon alpha-2 , Male , Middle Aged , Recombinant Proteins , Retrospective Studies , Ribavirin/therapeutic use , Treatment OutcomeABSTRACT
UNLABELLED: The aim of this study was to investigate the efficacy and safety of combination therapy of interferon and ribavirin for aged patients with chronic hepatitis C. METHODS: This study was conducted at Osaka University Hospital and institutions participating in the Osaka Liver Disease Study Group on 329 patients with chronic hepatitis C receiving interferon and ribavirin combination therapy (group A, under 60 year old, n=199; group B, 60-64 year old, n=64; group C, over 65 year old (mean age, 67.8+/-2.2 year old, n=66)). Of the 293 patients who were tested for HCV serotype and HCV viral loads, 215 had HCV-RNA with serotype 1 and high viral loads (1H) and the other 78 had HCV-RNA with serotype 2 or low viral loads (non-1H). RESULTS: In per-protocol analysis, the overall SVR rate of 1H patients was 28% (51/184). Among the 1H patients, the SVR rate was significantly lower in group C (16%) and group B (17%) than in group A (34%) (p<0.05). The overall SVR rate of non-1H patients was 85% (57/67). No significant difference was found in the SVR rate among group C (79%), group B (100%), and group A (84%). On the other hand, the discontinuance of both drugs due to side effects was 29% (19/66) in group C, 20% (13/64) in group B, and 11% (21/199) in group A, with the discontinuance rates being higher in the older group (p=0.002). CONCLUSIONS: In aged chronic hepatitis C patients, interferon and ribavirin combination therapy can be recommended for the non-1H patients who showed a high SVR rate of approximately 65%, but not for the 1H patients.
