Thrombocytopenia in pegylated interferon and ribavirin combination therapy for chronic hepatitis C

Abstract

Background: This study aimed to examine the therapeutic effect and prognostic indicators of pegylated interferon (PEG-IFN) and ribavirin (RBV) combination therapy in thrombocytopenic patients with chronic hepatitis C, hepatitis C virus (HCV)-related cirrhosis, and those who underwent splenectomy or partial splenic embolization (PSE).

Methods: Of 326 patients with HCV-related chronic liver disease (252 with genotype 1b and 74 with genotype 2a/2b) treated with PEG-IFN/RBV, 90 were diagnosed with cirrhosis.

Results: Regardless of the degree of thrombocytopenia, the administration rate was significantly higher in the splenectomy/PSE group compared to the cirrhosis group. However, in patients with genotype 1b, the sustained virological response (SVR) rate was significantly lower in the cirrhosis and the splenectomy/PSE groups compared to the chronic hepatitis group. No cirrhotic patients with platelets less than 80,000 achieved an SVR. Patients with genotype 2a/2b were more likely to achieve an SVR than genotype 1b. Prognostic factors for SVR in patients with genotype 1b included the absence of esophageal and gastric varices, high serum ALT, low AST/ALT ratio, and the major homo type of the IL28B gene. Splenectomy- or PSE-facilitated induction of IFN in patients with genotype 2a/2b was more likely to achieve an SVR by an IFN dose maintenance regimen. Patients with genotype 1b have a low SVR regardless of splenectomy/PSE. In particular, patients with a hetero/minor type of IL28B did not have an SVR.

Conclusions: Splenectomy/PSE for IFN therapy should be performed in patients expected to achieve a treatment response, considering their genotype and IL28B.

Fig. 1

Flow diagram of study patients

Fig. 2

The IFN dose until 24 weeks according to platelet count. The actual IFN dose rate until 24 weeks was evaluated as less than 50, 50–80, and 80 % of the normal dose. Group A, chronic hepatitis (plt ≥8); group B, chronic hepatitis (plt <8); group C, untreated cirrhosis group (plt ≥8); group D, untreated cirrhosis group (plt <8); group E, splenectomy/PSE

Fig. 3

a The sustained virological response (SVR) rate. b The SVR rate based on the IL28B genotype in patients with genotype 1b and high viral load. Twenty-five, two, and one patient from groups A, C, and D, respectively, were excluded because their IL28B genotype was not measured. Group B patients were excluded because only two patients underwent the examination