Granulocyte colony-stimulating factor dosing in pegylated interferon alpha-induced neutropenia and its impact on outcome of anti-HCV therapy.

Abstract

Many patients with chronic hepatitis C (HCV) infection undergoing treatment with pegylated interferon-alpha (PEG-IFN-alpha) and ribavirin develop neutropenia requiring dose reduction or granulocyte colony-stimulating factor (G-CSF) supplement. We analysed the database of patients who completed treatment for chronic HCV infection between 2003 and 2006. Patients with absolute neutrophil counts below 1000 cells/microL were initiated on G-CSF (G-CSF group) while a matching group of patients who received anti-HCV treatment without developing neutropenia were used as a control group (non-G-CSF group). Patients on the G-CSF arm were divided into two subgroups based on the timing of G-CSF administration relative to PEG-IFN-alpha administration. Of the 163 patients with HCV infection, 30 patients received G-CSF, most of who were maintained on 300 microg of G-CSF once a week. Administration of G-CSF 2 days before or after each dose of PEG-IFN-alpha did not make a significant difference in the neutrophil counts. In the G-CSF arm, 23 of 30 patients (77%) had undetectable end-of-treatment viral response which was comparable with 27 of 30 in the control group (90%; P = 0.17). There was no statistically significant difference in the sustained viral response between the two groups (61%vs 76%, P = 0.18). In most patients PEG-IFN-alpha induced neutropenia improved with a once-a-week dose of G-CSF with a comparable virological outcome. Timing of G-CSF administration did not make any significant impact on the patient's neutrophil counts but was better tolerated when given 2 days apart from PEG-IFN-alpha.

• Authors: J Koirala, S D Gandotra, S Rao, G Sangwan, A Mushtaq, T H Htwe, A Adamski, D Blessman, N M Khardori
• Journal: Journal of viral hepatitis (J Viral Hepat) Vol. 14 Issue 11 Pg. 782-7 (Nov 2007) ISSN: 1352-0504 [Print] England
• PMID: 17927614 (Publication Type: Journal Article)

Chemical References

• Antiviral Agents
• Interferon alpha-2
• Interferon-alpha
• Recombinant Proteins
• Granulocyte Colony-Stimulating Factor
• Polyethylene Glycols
• Ribavirin
• peginterferon alfa-2b
• peginterferon alfa-2a

Topics

• Antiviral Agents (administration & dosage, adverse effects, therapeutic use)
• Drug Therapy, Combination
• Female
• Granulocyte Colony-Stimulating Factor (administration & dosage)
• Hepacivirus (growth & development)
• Hepatitis C, Chronic (blood, drug therapy)
• Humans
• Interferon alpha-2
• Interferon-alpha (administration & dosage, adverse effects)
• Leukocyte Count
• Logistic Models
• Male
• Middle Aged
• Neutropenia (chemically induced, drug therapy)
• Polyethylene Glycols (administration & dosage, adverse effects)
• Recombinant Proteins
• Ribavirin (administration & dosage, therapeutic use)
• Time Factors
• Treatment Outcome