Jacobson Ira M, Kowdley Kris V, Kwo Paul Y
Chief of the Division of Gastroenterology and Hepatology Weill Cornell Medical College New York, New York.
Gastroenterol Hepatol (N Y). 2012 Sep;8(9 Suppl 6):1-16.
Boceprevir or telaprevir plus ribavirin (RBV) and pegylated interferon-α (pegIFN-α) is the new standard-of-care therapy for patients who are chronically infected with genotype 1 hepatitis C virus (HCV). The addition of these protease inhibitors to the RBV/pegIFN-α combination regimen has significantly improved rates of sustained virologic response (SVR); however, the incidence of anemia has also increased significantly. Anemia can interfere with patients' quality of life, work productivity, and treatment adherence. Severe anemia can cause morbidity and even mortality. For the management of anemia during triple combination therapy, RBV dose reduction is recommended as an initial course of action. Retrospective analyses of carefully selected patient cohorts suggest that RBV dose reduction does not reduce SVR rates. However, this observation needs to be confirmed in prospective trials with cohorts that more accurately reflect the challenging patients treated in real-world practice. Adequate doses of RBV should be maintained during triple combination therapy, as phase II trials have demonstrated that RBV is essential for attaining optimal SVR rates and preventing viral breakthrough, relapse, and emergence of resistant variants. This roundtable addresses key points related to the management of anemia in the era of triple combination therapy, including the increasing problem of anemia, strategies for anemia management, and the importance of maintaining adequate RBV exposure as part of the HCV treatment regimen.
博赛匹韦或特拉匹韦联合利巴韦林（RBV）及聚乙二醇化干扰素-α（pegIFN-α）是治疗慢性1型丙型肝炎病毒（HCV）感染患者的新的标准治疗方案。在RBV/pegIFN-α联合治疗方案中加入这些蛋白酶抑制剂可显著提高持续病毒学应答（SVR）率；然而，贫血的发生率也显著增加。贫血会干扰患者的生活质量、工作效率及治疗依从性。严重贫血可导致发病甚至死亡。对于三联联合治疗期间的贫血管理，建议首先采取降低RBV剂量的措施。对精心挑选的患者队列进行的回顾性分析表明，降低RBV剂量不会降低SVR率。然而，这一观察结果需要在前瞻性试验中得到证实，这些试验的队列应更准确地反映现实临床中接受治疗的具有挑战性的患者情况。在三联联合治疗期间应维持足够剂量的RBV，因为II期试验已证明，RBV对于实现最佳SVR率及预防病毒突破、复发和耐药变异株的出现至关重要。本次圆桌会议讨论了三联联合治疗时代贫血管理的关键问题，包括日益严重的贫血问题、贫血管理策略以及维持足够的RBV暴露作为HCV治疗方案一部分的重要性。
