[Dr.Vad]

Уважаемая Иринка!

Лечение рибавирином может вызывать гемолитическую анемию, очень хотелось бы взглянуть на данные, которые Вы упоминаете, тк согласно недавним амер. рекомендациям:

"уменьшение суточной дозы рибавирина на 200 мг при возникновении значительной анемии (гемоглобин < 100 г/л или гематокрит < 30%). Прекращение приема рибавирина при тяжелой анемии (гемоглобин < 85 г/л или гематокрит <26%)".

Тк клинический ответ может зависеть от суммарной дозы рибавирина, то многие врачи подыскивают новые подходы в лечении поб. эффектов, дабы удержать гемоглобин/гематокрит на необходимом уровне и тем самым не снижать дозу препарата - одним из таких вариантов коррекции может быть назначение эритропоэтина:

Am J Gastroenterol. 2003 Nov;98(11):2491-9.

Once-weekly epoetin alfa improves anemia and facilitates maintenance of ribavirin dosing in hepatitis C virus-infected patients receiving ribavirin plus interferon alfa.

Dieterich DT, Wasserman R, Brau N, Hassanein TI, Bini EJ, Bowers PJ, Sulkowski MS.

Mount Sinai School of Medicine, New York, New York 10029-6574, USA.

OBJECTIVE: The aim of this study was to determine the efficacy of epoetin alfa in alleviating anemia and minimizing ribavirin (RBV) dose reductions in patients with chronic hepatitis C virus (HCV) infection receiving combination RBV/interferon alfa (IFN) therapy. METHODS: HCV-infected patients who had Hb levels of 12 g/dl or less during the first 24 wk of combination RBV/IFN therapy (n=64) were randomized to treatment with epoetin alfa (40,000 units) s.c. q.w. or to standard of care (SOC) for anemia management (RBV dose reduction or discontinuation, transfusions). Primary and secondary efficacy endpoints were changes in Hb level and RBV dosage, respectively, from baseline to week 16 of epoetin alfa therapy.Based on intent-to-treat analysis, the mean changes from baseline Hb levels at week 16 were +2.8 g/dl for epoetin alfa versus +0.4 g/dl for SOC (p<0.0001), and the mean changes in RBV dosage were -34 mg/day for epoetin alfa versus -146 mg/day (p=0.060) for SOC. The mean Hb level at week 16 in the epoetin alfa group (13.8 g/dl) was significantly (p<0.0001) higher than that of the SOC group (11.4 g/dl). At week 4 and subsequently, significantly more patients in the epoetin alfa group did not have RBV dosage reductions (p<0.011). At study end, 83% of epoetin alfa-treated patients maintained RBV dosages of at least 800 mg/day, compared with 54% of patients receiving SOC (p=0.022). Epoetin alfa was well tolerated. CONCLUSIONS: In anemic HCV-infected patients treated with RBV/IFN, epoetin alfa increases Hb levels and maintains RBV dosing. Based on these results, epoetin alfa seems to be promising in the treatment of HCV treatment-related anemia. Further research is warranted to determine the potential impact on outcomes, including quality of life and sustained viral response rate.