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.