Administration of low‐dose epoetin‐alpha facilitates adherence to ribavirin in triple therapy with pegylated interferon‐alpha‐2b and telaprevir

<jats:sec><jats:title>Aim</jats:title><jats:p>Anemia frequently develops in patients given pegylated interferon, ribavirin (<jats:styled-content style="fixed-case">RBV</jats:styled-content>), telaprevir (<jats:styled-content style="fixed-case">TVR</jats:styled-content>) triple therapy and restricts treatment by forcing reduction or discontinuation of <jats:styled-content style="fixed-case">RBV</jats:styled-content> administration. We investigated whether erythropoietin (<jats:styled-content style="fixed-case">EPO</jats:styled-content>) could alleviate <jats:styled-content style="fixed-case">RBV</jats:styled-content>‐induced anemia to help maintain the <jats:styled-content style="fixed-case">RBV</jats:styled-content> dose during the first 12 weeks, the triple therapy phase.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Twenty‐two patients with hepatitis <jats:styled-content style="fixed-case">C</jats:styled-content> virus (<jats:styled-content style="fixed-case">HCV</jats:styled-content>) genotype 1 were enrolled. Hemoglobin (<jats:styled-content style="fixed-case">Hb</jats:styled-content>) concentration was measured every week. If Hb reduction from the baseline was 2 g/dL or more, 12 000 <jats:styled-content style="fixed-case">IU</jats:styled-content> of epoetin‐α was administrated. When further reduction (≥3 g/dL) was observed, 24 000 <jats:styled-content style="fixed-case">IU</jats:styled-content> of epoetin‐α was used. Inosine triphosphatase (<jats:styled-content style="fixed-case">ITPA</jats:styled-content>) single nucleotide polymorphism (rs1127354) was genotyped for all patients.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Among the 22 patients enrolled in this study, three required <jats:styled-content style="fixed-case">RBV</jats:styled-content> dose reduction due to anemia, two had to discontinue or reduce <jats:styled-content style="fixed-case">TVR</jats:styled-content> and <jats:styled-content style="fixed-case">RBV</jats:styled-content> due to creatinine elevation. The remaining 17 patients completed the treatment during the triple therapy phase without reduction of the <jats:styled-content style="fixed-case">RBV</jats:styled-content> dose or adverse events attributable to <jats:styled-content style="fixed-case">EPO</jats:styled-content>. Regardless of <jats:styled-content style="fixed-case">ITPA</jats:styled-content> genotype, <jats:styled-content style="fixed-case">Hb</jats:styled-content> decline was well controlled by <jats:styled-content style="fixed-case">EPO</jats:styled-content> administration, whereas the total <jats:styled-content style="fixed-case">EPO</jats:styled-content> dose tended to be higher in the <jats:styled-content style="fixed-case">CC</jats:styled-content> genotype group. The average adherence to <jats:styled-content style="fixed-case">RBV</jats:styled-content> during the triple therapy phase was 97.5%. <jats:styled-content style="fixed-case">SVR</jats:styled-content> was achieved in 17 patients; two patients had viral breakthrough and three patients had relapse of <jats:styled-content style="fixed-case">HCV RNA</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p><jats:styled-content style="fixed-case">EPO</jats:styled-content> can be a favorable alternative to reduction of <jats:styled-content style="fixed-case">RBV</jats:styled-content> to facilitate the adherence of patients on <jats:styled-content style="fixed-case">TVR</jats:styled-content>‐based triple therapy.</jats:p></jats:sec>