Al-Ghamdi Saeed M G, Alaulaqi Nasser, Al-Amoudi Abdullah A, Alghamdi Amenah, Zagnoon Abbas, Sadiq Bakr Ben
Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Department of Biostatistics-Research Center, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2017 Jul-Aug;28(4):799-805.
Hepatitis C virus (HCV) is a common infection affecting 15% of hemodialysis population in Saudi Arabia resulting in delay in transplantation and long-term complications. The use of peginterferon resulted in sustained virologic response (SVR) in 40%-85% of patients, especially if combined with ribavirin. The treatment is hampered by the high dropout due to anemia and requirement of blood transfusion resulting from this therapy. Some studies have shown that the addition of increasing dose of erythropoiesis-stimulating agents (ESA) and reduced dose of ribavirin results in reduced dropout rate with high SVR. We conducted an open-label prospective study using either peginterferon α-2a alone (Group I, 32 patients) or peginterferon α-2a plus adjusted dose ribavirin (Group II, 26 patients). A total of seven patients dropped from the study (2 in Group I and 5 in Group II). Analysis was done only on patients who completed the study (thirty patients in Group I and 21 in Group II). There was no significant difference in the demographic data, HCV genotype, liver biopsy grade and stage, and laboratory tests between the two groups. Patients received ESA to combat expected anemia. Group II had a better early virologic response than Group I [17 out of 21 (80%) and 14 out of 30 (47%) respectively, P = 0.014] and better SVR [18 out of 21 (85%) and 15 out of 30 (50%) respectively, P = 0.009]. There were no differences in mean white blood cells, hemoglobin, and platelets between the two groups at any time with only four patients dropping out due to anemia or side effect of medications. Alanine aminotransferase was lower in both treatment groups compared to baseline with no difference between the groups. Peginterferon α-2a and ribavirin are superior to peginterferon α-2a alone in treating hemodialysis patients with chronic HCV infection.
丙型肝炎病毒（HCV）是一种常见感染，在沙特阿拉伯影响着15%的血液透析人群，导致移植延迟和长期并发症。聚乙二醇干扰素使40%-85%的患者实现了持续病毒学应答（SVR），尤其是与利巴韦林联合使用时。由于贫血导致的高退出率以及该疗法所需的输血需求，治疗受到了阻碍。一些研究表明，增加促红细胞生成素（ESA）剂量并减少利巴韦林剂量可降低退出率并提高SVR。我们进行了一项开放标签前瞻性研究，使用单独的聚乙二醇干扰素α-2a（第一组，32例患者）或聚乙二醇干扰素α-2a加调整剂量的利巴韦林（第二组，26例患者）。共有7例患者退出研究（第一组2例，第二组5例）。仅对完成研究的患者进行分析（第一组30例患者，第二组21例患者）。两组在人口统计学数据、HCV基因型、肝活检分级和分期以及实验室检查方面无显著差异。患者接受ESA以对抗预期的贫血。第二组的早期病毒学应答优于第一组[分别为21例中的17例（80%）和30例中的l4例（47%），P = 0.014]，SVR也更好[分别为21例中的18例（85%）和30例中的15例（50%），P = 0.009]。两组在任何时候的平均白细胞、血红蛋白和血小板均无差异，仅有4例患者因贫血或药物副作用退出。与基线相比，两个治疗组的丙氨酸转氨酶均较低，组间无差异。聚乙二醇干扰素α-2a和利巴韦林在治疗慢性HCV感染的血液透析患者方面优于单独使用聚乙二醇干扰素α-2a。
