聚乙二醇干扰素/利巴韦林治疗地中海贫血合并慢性丙型肝炎患者的疗效及对输血需求的影响。
The treatment outcome and impact on blood transfusion demand of Peg-interferon/ribavirin in thalassemic patients with chronic hepatitis C.
机构信息
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.
出版信息
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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。
方法
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。
结果
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）。
结论
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。
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