Graduate Institute of Clinical Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Special Hematologic Disease Service Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Formos Med Assoc. 2018 Jan;117(1):14-23. doi: 10.1016/j.jfma.2017.10.001. Epub 2017 Oct 31.
BACKGROUND/AIMS: Hepatitis C virus (HCV) prevails in patients with thalassemia. We aimed to investigate the efficacy, safety, and impact on red blood cells (RBC) transfusion demand of pegylated interferon (Peg-IFN)/ribavirin therapy in thalassemic patients with HCV.
This retrospective study included 18 thalassemic patients (16 with HCV-1b, one HCV-1b/2b, and one HCV-2b) and 54 consecutive sex- and genotype-matched controls. Patients with HCV-2, or HCV-1 or mixed HCV-1/2 with lower viral loads plus rapid virological response (RVR) received 24-week Peg-IFN/ribavirin; whereas HCV-1 or mixed HCV-1/2 with higher viral loads or without RVR received 48-week regimens.
The rates of RVR, complete early virological response, and sustained virological response (SVR) in thalassemic patients were 72.2% (13/18), 94.1% (16/17), and 77.8% (14/18), which resembled those of controls (63.0%, 94.4%, and 81.5%, respectively). RVR was the only significant factor associated with SVR in thalassemic group, and was the strongest predictor for SVR among both groups (OR/95% CI = 14.7/2.20-98.6), followed by male gender and lower viral loads. More proportion of interleukin-28B-TT carriage were observed among thalassemic patients with SVR versus non-SVR (78.6% vs. 50.0%). Thalassemic patients experienced significantly less 80/80/80 adherence, more ribavirin reduction and serious adverse events than controls. Notably, there was a decreased post-treatment RBC transfusion demand versus baseline in thalassemic patients with SVR (5.21 vs. 5.64 units/month, p = 0.05), but not in those without SVR (6.33 vs. 6.56 units/month, p = 0.54).
Peg-IFN/ribavirin was effective and tolerable for thalassemic HCV patients. Successful antiviral therapy might have extra benefit of reducing the post-treatment transfusion demand.
背景/目的：丙型肝炎病毒（HCV）在地中海贫血患者中流行。我们旨在研究聚乙二醇干扰素（Peg-IFN）/利巴韦林治疗对地中海贫血合并 HCV 患者的疗效、安全性和对红细胞（RBC）输血需求的影响。
本回顾性研究纳入了 18 例地中海贫血患者（16 例 HCV-1b，1 例 HCV-1b/2b，1 例 HCV-2b）和 54 例连续性别和基因型匹配的对照者。HCV-2、HCV-1 或 HCV-1/2 混合且病毒载量较低加快速病毒学应答（RVR）的患者接受 24 周 Peg-IFN/利巴韦林治疗；而 HCV-1 或 HCV-1/2 混合且病毒载量较高或无 RVR 的患者接受 48 周治疗方案。
地中海贫血患者的 RVR、完全早期病毒学应答和持续病毒学应答（SVR）率分别为 72.2%（13/18）、94.1%（16/17）和 77.8%（14/18），与对照组相似（分别为 63.0%、94.4%和 81.5%）。RVR 是地中海贫血组中与 SVR 相关的唯一显著因素，是两组中 SVR 的最强预测因素（OR/95%CI=14.7/2.20-98.6），其次是男性和较低的病毒载量。SVR 的地中海贫血患者携带白细胞介素 28B-TT 的比例明显高于非 SVR 患者（78.6%比 50.0%）。与对照组相比，地中海贫血患者的 80/80/80 依从性显著降低，利巴韦林减少和严重不良事件更多。值得注意的是，与基线相比，SVR 的地中海贫血患者的治疗后 RBC 输血需求降低（5.21 比 5.64 单位/月，p=0.05），而非 SVR 的患者则没有（6.33 比 6.56 单位/月，p=0.54）。
Peg-IFN/利巴韦林对地中海贫血合并 HCV 患者有效且耐受良好。成功的抗病毒治疗可能具有降低治疗后输血需求的额外益处。
