Page 23 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral Therapy: The Basics
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counts go up, treatment can be restarted, but at a reduced
Peg IFN dose;
– use of stimulating factors (i.e. Filgastrim™ - granulocyte
macrophage colony stimulating factor or Eltrombopag™ -an
oral thrombopoietin receptor agonist) is not routinely
recommended in clinical practice, except for patients with
cirrhosis.
Neuropsychiatric symptoms such as depression, irritability,
insomnia, and, occasionally, aggressive behavior are some of the
most debilitating AEs of PegIFN therapy, occurring in
approximately 20% to 30% of patients after the first month of
treatment. Interventions may require an initial dose reduction,
followed by permanent discontinuation of IFN in the case of
persistently severe or worsening symptoms. In most cases, the
neuropsychiatric symptoms resolve after PegIFN
discontinuation. A multidisciplinary approach, including medical
treatment (administration of antidepressants – especially
serotonin uptake inhibitors and benzodiazepines, when
required) and psychiatric counseling is needed in order to
reduce the psychiatric side effects of antiviral therapy.
Autoimmune disorders involve most commonly the
development of autoimmune thyroiditis, but HCV infection has
been also related to mixed cryoglobulinemia, thyroid
dysfunction and papillary thyroid cancer. There is ample
evidence showing that 7–11% of HCV-infected patients have
thyroid dysfunction (frequently consistent with hypothyroidism,
with increases in thyroid-stimulating hormone -TSH and
decreases in free thyroxin -T4 -mean values) prior to the
initiation of treatment. This percentage goes up to 15-20%, once
combined PegIFN/RBV therapy is initiated. Thyroid function
should be monitored routinely before and during treatment,
with TSH and T4 levels measured every 12 weeks while on
therapy and again at 6 months after the end of treatment.
Specific therapy may be needed to maintain a euthyroid state.
A series of other side effects are reported at lower rates, such as
pulmonary (cough, dyspnea), cardiovascular (cardiomyopaty,