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. 2016 Mar 18;11(3):e0151238.
doi: 10.1371/journal.pone.0151238. eCollection 2016.

Hemoglobin Decrease with Iron Deficiency Induced by Daclatasvir plus Asunaprevir Combination Therapy for Chronic Hepatitis C Virus Genotype 1b

Nobuyuki Matsumoto  1 , Hiroki Ikeda  1 , Ryuta Shigefuku  1 , Nobuhiro Hattori  1 , Tsunamasa Watanabe  1 , Kotaro Matsunaga  1 , Tetsuya Hiraishi  1 , Tomohiro Tamura  1 , Yohei Noguchi  1 , Yasunobu Fukuda  1 , Toshiya Ishii  1 , Chiaki Okuse  1 , Akira Sato  1 , Michihiro Suzuki  1 , Fumio Itoh  1
Affiliations

Hemoglobin Decrease with Iron Deficiency Induced by Daclatasvir plus Asunaprevir Combination Therapy for Chronic Hepatitis C Virus Genotype 1b

Nobuyuki Matsumoto et al. PLoS One. .

Abstract

Background: Decreased hemoglobin (Hb) level has been supposed to be a relatively rare side effect of a combination therapy against hepatitis C virus that consists of the NS5A inhibitor daclatasvir (DCV) and the NS3/4A protease inhibitor asunaprevir (ASV).

Methods: The study was conducted in 75 patients with genotype 1b chronic hepatitis C virus infection who had started combination therapy with DCV and ASV at St. Marianna University School of Medicine Hospital between September 2014 and December 2014.

Results: Among the patients examined, decreased Hb level by ≥1.5 g/dL from the values at treatment initiation was observed in 11 individuals. This was accompanied by decreased mean corpuscular volume, and iron and ferritin levels.

Conclusions: These findings suggest that the mechanism of the phenomenon is caused by iron deficiency. The underlying mechanism and clinical impacts will need to be further examined.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Change in (A) MCV, (B) serum iron level, and (C) ferritin level at the time of the decrease in Hb level Median values and interquartile ranges are indicated. A paired t test was performed for MCVs and serum iron levels, and the Wilcoxon signed-rank test was performed for the ferritin levels.
Fig 2
Fig 2. Clinical coarse of a representative case.
Fig 3
Fig 3. Recovery of decreased Hb level after DCV/ASV treatment Mean values and SDs of the Hb levels at each time point are indicated.
pre: the baseline Hb level, bottom: the lowest Hb level during DCV/ASV treatment, post 24W: Hb levels at 24 weeks after the DCV/ASV treatment.
See this image and copyright information in PMC

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