Short Guide to Hepatitis C_4

Đếm tiểu cầu. Điều này giới hạn việc sử dụng IFN trên bệnh nhân xơ gan là gan nâng cao Ai cũng dễ bị nhiễm. Các thrombopoietin miệng eltrombopag chủ vận thụ thể đã được thử nghiệm trên bệnh nhân viêm gan C mãn tính và xơ gan gan (McHutchinson 2007).
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Short Guide to Hepatitis C_440 | Hepatitis C Guideplatelet counts. This limits the use of IFN in patients withadvanced liver cirrhosis who are also more vulnerable toinfections. The oral thrombopoietin receptor agonisteltrombopag has been tested in patients with chronic hepatitis Cand liver cirrhosis (McHutchinson 2007). Eltrombopag increasedplatelet levels in 75-95% of patients depending on the dose, andantiviral therapy was then initiated. It remains unapproved forthis indication. Neutropenia is another common reason for dose modification.Granulocyte macrophage colony-stimulating factor andgranulocyte colony-stimulating factor could be used to stabilizeneutrophil counts during IFN therapy (Shiffman 1998, Van Thiel1997, Younossi 2008). However cost-benefit analyses and furthertrials are required to establish routine use of these agents. Flu-like symptoms usually occur during the first weeks oftreatment and severity declines over time. These symptomsinclude fever, chills, headache, arthralgia, and myalgia (Chapter6, Table 7). Antipyretic drugs such as paracetamol can help toprevent or reduce these side effects. Neuropsychiatric side effects such as irritability, severefatigue, and apathy are also frequent and pose a great problemfor many patients and their family members. When severe, sideeffects may reduce adherence to therapy and may result in dosemodifications resulting in suboptimal responses. Severedepression can occur and suicide has been reported (Manns2006). Psychiatric care and the use of antidepressants, especiallyselective serotonin reuptake inhibitors (SSRIs) are highlyeffective in HCV patients during IFN-based therapies, whenstarting early after the onset of clinically relevant depression(Schaefer 2005, Krauss 2008). IFN has immunomodulatory properties, and treatment caninduce autoimmune phenomena (Wesche 2001). This may not be This is trial versionreversible on stopping therapy (Lisker-Melman 1992). Other www.adultpdf.com | 41 4. Hepatitis C Standard of Careautoimmune diseases can be aggravated by IFN therapy (e.g.,diabetes or autoimmune hepatitis). LKM antibody-positiveindividuals require careful monitoring if IFN is considered astreatment. However, IFN therapy seems safe in mostHCV/anti-LKM-1-positive patients (Todros 1995).Table 4.3 – Common side effects (>20% of patients) recorded in themajor PEG-IFN/ribavirin trials.* Incidence with PEG-IFN α and ribavirinSide effects (Reddy 2007, Zeuzem 2009)Headache 47-62%Pyrexia 40-46%Myalgia 37-56%Rigor 24-48%Arthralgia 24-34%Nausea 35-43%Loss of appetite 21%Weight loss 29%Diarrhea 22%Alopecia 21-36%Rash/Dermatitis 20-24%Injection site inflammation 25%Pruritus 25-29%Dyspnea 26%Fatigue 48-64%Insomnia 33-40%Irritability 24-35%Depression 22-31%* It is difficult to compare side effects between studies because of significantdifferences in genetic and socioeconomic backgrounds, methodologicaldifferences in side effect assessment, and study inclusion and exclusion criteria.Normal TSH levels pretreatment were a prerequisite. This is trial version www.adultpdf.com42 | Hepatitis C GuideRibavirin The main side effect of ribavirin is haemolytic anaemia thatfrequently results in ribavirin dose reduction or evendiscontinuation, especially in patients with HCV genotype 1(Reddy 2007). Treatment with erythropoietin can effectivelyreverse ribavirin-associated anaemia, improving quality of lifeand allowing for easier adherence to ribavirin (Afdahl 2004).However, no difference in SVR was seen in these trials anderythropoietin is off-label in many countries. See Chapter 6 formore on adverse events.Special populationsPatients with normal aminotransferase levels Approximately 30% of patients with chronic hepatitis Cmaintain persistently normal alanine aminotransferase (ALT)levels despite having detectable HCV RNA in serum. Treatmentindication should not be based on ALT values (Sarrazin 2010). Pa-tients with normal ALT who present with significant liverfibrosis do need an effective treatment. PEG-IFN α plus ribavirinhas been shown to be successful (Zeuzem 2004b); the efficacy andtolerability seem to be comparable to that seen in patients withelevated ALT levels.HCV and liver transplantation HCV re-infec ...