Ribavirin/telaprevir/peginterferon
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Reactions 1493, p38 - 22 Mar 2014 S Ribavirin/telaprevir/peginterferon Rash, anaemia and virological failure: 2 case reports Two patients with chronic hepatitis C virus (HCV) genotype 1 developed rash, anaemia and virological failure after receiving triple therapy with telaprevir, peginterferon and ribavirin. A 53-year-old woman with chronic HCV genotype 1 and cirrhosis with a previous partial response to peginterferon and ribavirin, was commenced on triple therapy with peginterferon, telaprevir and ribavirin [routes and dosages not stated]. During therapy she developed anaemia [duration of therapy before reaction onset not stated]. The woman’s ribavirin dose was reduced and she was given erythropoietin. She also developed a rash, which resolved once telaprevir was stopped. Her viral load was undetectable by week 8 of therapy. Peginterferon and ribavirin were discontinued after 48 weeks. One month later, she presented with a 5lb weight gain, and new onset ascites. Investigations showed virological relapse, with an HCV viral load of 228 IU/mL. She was started on diuretics and a low-sodium diet. Three months after the end of therapy her HCV viral load was 528 810 IU/mL. Her ascites had resolved 7 months after the end of therapy. A 61-year-old woman with chronic HCV genotype 1 and cirrhosis was started on peginterferon, ribavirin and telaprevir [routes and dosages not stated]. She achieved a rapid virological response after therapy initiation. However, side effects of the therapy included anaemia [duration of therapy before reaction onset not stated]. The woman’s ribavirin dose was decreased, and she was administered erythropoietin. She also developed a severe facial rash. Therapy was discontinued and she required systemic steroids for 2 days. Her HCV viral load was undetectable from week 4 until the end of therapy. She presented 1 month after therapy completion with an 8lb weight gain, and new onset ascites was discovered. HCV viral load was undetectable at this timepoint, but was 203 IU/L at 3 months after therapy, and 69 900 IU/mL on repeat measurement, confirming relapse. Ascites was controlled with diuretics and a low-sodium diet. Author comment: "[W]e propose that the development of ascites after completion of therapy was due to the adverse impact of acute inflammation associated with virological relapse on portal pressures." "Side effects of therapy included anemia, requiring ribavirin dose reduction and erythropoietin therapy." Chua DL, et al. New-onset ascites as a manifestation of virologic relapse in patients with hepatitis C cirrhosis. Hepatic Medicine: Evidence and Research 6: 11-14, 29 Jan 2014. Available from: URL: http://www.dovepress.com/ getfile.php?fileID=18831 - USA 803100523 1 Reactions 22 Mar 2014 No. 1493 0114-9954/14/1493-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
Transcript of Ribavirin/telaprevir/peginterferon
Reactions 1493, p38 - 22 Mar 2014
SRibavirin/telaprevir/peginterferon
Rash, anaemia and virological failure: 2 casereports
Two patients with chronic hepatitis C virus (HCV)genotype 1 developed rash, anaemia and virological failureafter receiving triple therapy with telaprevir, peginterferon andribavirin.
A 53-year-old woman with chronic HCV genotype 1 andcirrhosis with a previous partial response to peginterferon andribavirin, was commenced on triple therapy withpeginterferon, telaprevir and ribavirin [routes and dosages notstated]. During therapy she developed anaemia [duration oftherapy before reaction onset not stated]. The woman’sribavirin dose was reduced and she was given erythropoietin.She also developed a rash, which resolved once telaprevir wasstopped. Her viral load was undetectable by week 8 of therapy.Peginterferon and ribavirin were discontinued after 48 weeks.One month later, she presented with a 5lb weight gain, andnew onset ascites. Investigations showed virological relapse,with an HCV viral load of 228 IU/mL. She was started ondiuretics and a low-sodium diet. Three months after the end oftherapy her HCV viral load was 528 810 IU/mL. Her asciteshad resolved 7 months after the end of therapy.
A 61-year-old woman with chronic HCV genotype 1 andcirrhosis was started on peginterferon, ribavirin and telaprevir[routes and dosages not stated]. She achieved a rapidvirological response after therapy initiation. However, sideeffects of the therapy included anaemia [duration of therapybefore reaction onset not stated]. The woman’s ribavirin dosewas decreased, and she was administered erythropoietin. Shealso developed a severe facial rash. Therapy was discontinuedand she required systemic steroids for 2 days. Her HCV viralload was undetectable from week 4 until the end of therapy.She presented 1 month after therapy completion with an 8lbweight gain, and new onset ascites was discovered. HCV viralload was undetectable at this timepoint, but was 203 IU/L at3 months after therapy, and 69 900 IU/mL on repeatmeasurement, confirming relapse. Ascites was controlled withdiuretics and a low-sodium diet.
Author comment: "[W]e propose that the development ofascites after completion of therapy was due to the adverseimpact of acute inflammation associated with virologicalrelapse on portal pressures." "Side effects of therapy includedanemia, requiring ribavirin dose reduction and erythropoietintherapy."Chua DL, et al. New-onset ascites as a manifestation of virologic relapse inpatients with hepatitis C cirrhosis. Hepatic Medicine: Evidence and Research 6:11-14, 29 Jan 2014. Available from: URL: http://www.dovepress.com/getfile.php?fileID=18831 - USA 803100523
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Reactions 22 Mar 2014 No. 14930114-9954/14/1493-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
