Drug-induced hematotoxicity is the most common reason for reducing the dose or withdrawing
ribavirin (RBV) and
interferon (IFN)
therapy in
chronic hepatitis C, which leads to the elimination of a possible cure for the patient. Traditionally, severe
anemia and
neutropenia have been considered as absolute
contraindications to start
antiviral therapy. This has not however, been the case since the advent of adjunct
therapy with hematopoietic
growth factors (
erythropoietin (EPO) and
granulocyte-colony stimulating factor (
G-CSF)). Some recent landmark studies have used this adjunct
therapy to help avoid
antiviral dose reductions. Although the addition of this adjunct
therapy has been shown to significantly increase the overall cost of the treatment, this extra cost is worth bearing if the
infection is cured at the end of the day. Although more studies are needed to refine the true indications of this adjunct
therapy, determine the best dose regimen, quantify the average extra cost and determine whether or not the addition of this
therapy increases the sustained virological response rates achieved, the initial reports are encouraging. Therefore, although not recommended on a routine basis, some selected patients may be given the benefits of these factors. This article reviews the current literature on this subject and makes a few recommendations to help develop local guidelines.