Combination Therapy with Pegylated Interferon Plus Ribavirin in the Treatment of Hepatitis C Virus-related Thrombocytopenia

Overview

Journal Curr Ther Res Clin Exp

Specialty Pharmacology

Date 2014 Apr 26

PMID 24764593

Authors

Tarkan Karakan

Mehmet Cindoruk

Bulent Degertekin

Ibrahim Dogan

Alper Sancak

Sukru Dumlu

Ahmet Gorgul

Selahattin Unal

Affiliations

Soon will be listed here.

Abstract

Background: Isolated thrombocytopenia is a common manifestation of hepatitis C virus (HCV) infection. There is no established treatment modality for this condition. The efficacy of standard interferon (IFN) monotherapy has been reported in some studies. The major disadvantage of this treatment is the high rate of recurrence due to viral breakthrough during the first 12 weeks of treatment. Pegylated IFNs are now the standard regimen for chronic hepatic disease due to HCV infection. However, due to a lack of evidence, pegylated IFNs are not widely used for HCV-related isolated thrombocytopenia.

Objective: The aim of this report was to present the case of a male patientwith severe symptomatic thrombocytopenia due to HCV infection.

Methods: Thrombocytopenia was treated with pegylated IFN plus ribavirin.

Results: Although standard IFN monotherapy failed to achieve virologic and hematologic improvement, therapy with pegylated IFN alfa-2a plus ribavirin was associated with both virologic and hematologic improvement without any significant adverse effects.

Conclusions: Pegylated IFN plus ribavirin was effective in this patient for thetreatment of HCV-related thrombocytopenia. However, further research is needed to define the response rate in different patient populations.

References

Hamaia S, Li C, Allain J . The dynamics of hepatitis C virus binding to platelets and 2 mononuclear cell lines. Blood. 2001; 98(8):2293-300. DOI: 10.1182/blood.v98.8.2293. View

Ramos-Casals M, Garcia-Carrasco M, Lopez-Medrano F, Trejo O, Forns X, Lopez-Guillermo A . Severe autoimmune cytopenias in treatment-naive hepatitis C virus infection: clinical description of 35 cases. Medicine (Baltimore). 2003; 82(2):87-96. DOI: 10.1097/00005792-200303000-00003. View

Gumber S, Chopra S . Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations. Ann Intern Med. 1995; 123(8):615-20. DOI: 10.7326/0003-4819-123-8-199510150-00008. View

Hadziyannis S, Sette Jr H, Morgan T, Balan V, Diago M, Marcellin P . Peginterferon-alpha2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med. 2004; 140(5):346-55. DOI: 10.7326/0003-4819-140-5-200403020-00010. View

Manns M, McHutchison J, Gordon S, Rustgi V, Shiffman M, Reindollar R . Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet. 2001; 358(9286):958-65. DOI: 10.1016/s0140-6736(01)06102-5. View

Durand J, Cretel E, Retornaz F, Lefevre P, Kaplanski G, Soubeyrand J . Alpha interferon therapy in thrombocytopenia associated with hepatitis C virus infection. J Hepatol. 1994; 21(2):277-8. DOI: 10.1016/s0168-8278(05)80409-x. View

Kosugi S, Tomiyama Y, Shiraga M, Kashiwagi H, Mizutani H, Kanakura Y . Platelet-associated anti-glycoprotein (GP) IIb-IIIa autoantibodies in chronic immune thrombocytopenic purpura mainly recognize cation-dependent conformations: comparison with the epitopes of serum autoantibodies. Thromb Haemost. 1996; 75(2):339-45. View

Goulis J, Chau T, Jordan S, Mehta A, Watkinson A, Rolles K . Thrombopoietin concentrations are low in patients with cirrhosis and thrombocytopenia and are restored after orthotopic liver transplantation. Gut. 1999; 44(5):754-8. PMC: 1727482. DOI: 10.1136/gut.44.5.754. View

Wang C, Yao W, Wang S, Chang T, Chou P . Strong association of hepatitis C virus (HCV) infection and thrombocytopenia: implications from a survey of a community with hyperendemic HCV infection. Clin Infect Dis. 2004; 39(6):790-6. DOI: 10.1086/423384. View

10.

Leroy V, Arvieux J, Jacob M, Maynard-Muet M, Baud M, Zarski J . Prevalence and significance of anticardiolipin, anti-beta2 glycoprotein I and anti-prothrombin antibodies in chronic hepatitis C. Br J Haematol. 1998; 101(3):468-74. DOI: 10.1046/j.1365-2141.1998.00722.x. View

11.

Sanjo A, Satoi J, Ohnishi A, Maruno J, Fukata M, Suzuki N . Role of elevated platelet-associated immunoglobulin G and hypersplenism in thrombocytopenia of chronic liver diseases. J Gastroenterol Hepatol. 2003; 18(6):638-44. DOI: 10.1046/j.1440-1746.2003.03026.x. View

12.

Kosugi S, Imai Y, Kurata Y, Tomiyama Y, Shiraga M, Honda S . Platelet-associated IgM elevated in patients with chronic hepatitis C contains no anti-platelet autoantibodies. Liver. 1997; 17(5):230-7. DOI: 10.1111/j.1600-0676.1997.tb01023.x. View

13.

Lerat H, Rumin S, Habersetzer F, Berby F, Trabaud M, Trepo C . In vivo tropism of hepatitis C virus genomic sequences in hematopoietic cells: influence of viral load, viral genotype, and cell phenotype. Blood. 1998; 91(10):3841-9. View

14.

Linares M, Pastor E, Hernandez F, Montagud M, Blanquer A . Autoimmune thrombocytopenia and hepatitis C virus infection. Am J Hematol. 1996; 53(4):284. DOI: 10.1002/(SICI)1096-8652(199612)53:4<284::AID-AJH20>3.0.CO;2-B. View

15.

Pivetti S, Novarino A, Merico F, Bertero M, Brunetto M, Bonino F . High prevalence of autoimmune phenomena in hepatitis C virus antibody positive patients with lymphoproliferative and connective tissue disorders. Br J Haematol. 1996; 95(1):204-11. DOI: 10.1046/j.1365-2141.1996.7542376.x. View

16.

Fried M, Shiffman M, Reddy K, Smith C, Marinos G, Goncales Jr F . Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 2002; 347(13):975-82. DOI: 10.1056/NEJMoa020047. View

17.

George J . Platelets. Lancet. 2000; 355(9214):1531-9. DOI: 10.1016/S0140-6736(00)02175-9. View

18.

de Almeida A, Campos-de-Magalhaes M, de Melo Marcal O, Brandao-Mello C, Okawa M, de Oliveira R . Hepatitis C virus-associated thrombocytopenia: a controlled prospective, virological study. Ann Hematol. 2004; 83(7):434-40. DOI: 10.1007/s00277-004-0844-0. View

19.

Bordin G, Ballare M, Zigrossi P, Bertoncelli M, Paccagnino L, Baroli A . A laboratory and thrombokinetic study of HCV-associated thrombocytopenia: a direct role of HCV in bone marrow exhaustion?. Clin Exp Rheumatol. 1995; 13 Suppl 13:S39-43. View

20.

Bauduer F, Marty F, Larrouy M, Ducout L . Immunologic thrombocytopenic purpura as presenting symptom of hepatitis C infection. Am J Hematol. 1998; 57(4):338-40. DOI: 10.1002/(sici)1096-8652(199804)57:4<338::aid-ajh12>3.0.co;2-4. View