Page 21 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral Therapy: The Basics
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Treatment interruption due to AEs are more frequent in
patients receiving PegIFN/RBV for the longer duration of 48
weeks.
All studies show the importance of adherence (McHutchison
2002) using the 80/80/80 rule (patients who took more than 80%
of their prescribed IFN, more than 80% of their prescribed RBV,
and are treated for more than 80% of the planned treatment
duration). Adherence seems to be influenced by several patients‘
baseline characteristics: HIV coinfection; previous HCV
treatment regimen; use of illicit drugs.
Adverse effects associated with therapy
In clinical trials, approximately 10–15% of patients discontinue
PegIFN/RBV therapy due to AEs; however, in clinical practice,
the rate of treatment withdrawal has been reported to be
substantially higher.
In addition, dose reduction of PegIFN and/or RBV owing to AEs
is necessary in 25–40% of patients (especially in elderly and in
those with low baseline hemoglobin level). Importantly, dose
reduction should be implemented at the earliest possible stage,
when slight signs of AEs are noted. Combination therapy should
then be prolonged to ensure the full scheduled doses of therapy.
Regional and global variability exists in the nature of AEs and
in the strategies employed to mitigate their impact (Sulkowsky
2011).
Influenza-like symptoms (such as fatigue, headache, fever,
and rigors) occur in virtually all patients after the first doses of
PegIFN, but usually subside after the first month of treatment.
Dermatologic effects (alopecia, dermatitis) and gastrointestinal
symptoms (nausea, diarrhea) are also very frequent. The most
prevailing severe AEs are
– hematologic
– neuropsychiatric
– autoimmune
Anemia occurrs in more than 30% of treated patients. Usually,
the lowest hemoglobin (Hb) values are recorded 6-8 weeks after