Tolerability of Peg interferon-alpha2b and Ribavirin therapy in patients with chronic hepatitis C and glucose-6-phosphate dehydrogenase deficiency

The Impact of the G6PD Gene Mutations in Patients with Chronic Hepatitis C Infection Treated with Direct-Acting Antivirals: A Multicenter Observational Study

Following the advent of direct-acting antivirals (DAAs), the treatment of hepatitis C virus (HCV) infection is now rarely challenging. However, data are still limited concerning DAA use in patients affected by glucose-6-phosphate dehydrogenase deficiency (G6PDd). Based on these considerations, the goal of this study was to evaluate the effectiveness and safety of DAAs in this subpopulation. A retrospective multicenter observational study (2015-2023) was conducted on all 2754 consecutive HCV-positive patients treated with first- and second-generation all-oral DAAs, and with a G6PDd diagnosis confirmed by quantitative testing (n = 38). At the treating clinician's discretion, an enhanced clinical and laboratory follow-up was performed, generally on a monthly basis both during treatment and up to six months after the end of it. Concerning hematochemical parameters, no significant differences were found between any considered time point. In all cases, no treatment-related adverse events were reported, and virologic response rates were as expected without G6PDd. In conclusion, in a large experience which, to the best of our knowledge, is unprecedented in the literature, the treatment of HCV hepatitis with nearly all available DAAs in patients with G6PDd as a comorbidity-a common occurrence in countries such as Italy-proved to be highly effective and safe.

Treatment of chronic hepatitis C in sickle cell disease and thalassaemic patients with interferon and ribavirin

BACKGROUND/AIM

Hepatic complications are a major cause of death in patients with congenital anaemia and chronic hepatitis C. Ribavirin is usually contraindicated in patients with haemolytic anaemia. This pilot study evaluated the efficacy and safety of antiviral treatment in patients with sickle cell disease (SCD) or beta-thalassaemia major (TM).

METHODS

Eleven consecutive SCD and TM patients were included. Interferon monotherapy was administrated in the two first thalassaemic patients. Other patients received combination therapy with full dose of pegylated interferon 2b and increasing doses of ribavirin, starting with a low dose of ribavirin (400 mg/day).

RESULTS

Hepatitis C virus genotypes were 1 or 4 in nine cases. A sustained virological response achieved in five of 11 patients despite unfavourable factors to response (genotypes, nonresponders to an earlier treatment). Haemoglobin level at the end of treatment was higher than baseline levels in five of six SCD patients. No SCD patient needed a transfusion during and after treatment period, neither presented vasoocclusive crisis. The mean increase in transfusion requirements was 32.5% in the thalassaemic group.

CONCLUSION

A sustained virological response can be obtained in SCD and TM patients. No earlier study of excellent haematological tolerance among SCD patients under ribavirin has been reported to date. The results of this study suggest that full dose ribavirin could be used from the start of treatment in SCD patients.