Erythropoietin and Hepatitis C Therapy: Useful Adjuvant Therapy but Remember to Treat the Patient and Not Just a Number

Abstract

For most of the decade, the commercial availability of peginterferon (pegIFN) and ribavirin (RBV) combination therapy for the treatment of chronic hepatitis C virus (HCV) has allowed both patients and health care professionals alike to expect a reasonable likelihood of long-term viral clearance. Both pegIFN and RBV combination products (ie, pegIFN α-2a and RBV, [Pegasys RBV, Hoffman-La Roche Ltd, Canada], and pegIFN α-2b and RBV, [Pegetron, Schering Canada Inc]) are associated with sustained virological response (SVR) probabilities of approximately 40% to 50% for genotype 1 and approaching 80% for genotypes 2 and 3 (1-3). Moreover, the impressive results reported in randomized clinical trials have also been reported in a retrospective analysis of clinical practice (4), going against the common wisdom that results obtained in a ‘real world’ clinical setting cannot match those obtained in the ‘ideal world’ of controlled trials. Despite this great optimism regarding HCV treatment, the cold hard reality is that pegIFN and RBV combination therapy is lengthy, taking approximately 24 to 48 weeks depending on the genotype; has many adverse effects, such that it is an unpleasant experience for many and punishing for some; and is very expensive, with an associated drug acquisition cost of $10,000 to $20,000 for 24 and 48 weeks of therapy, respectively. Although it would appear intuitive for any treatment regimen, that to maximize the likelihood of success one must take as much of the drug as possible, for pegIFN and RBV therapy, given the mentioned problems associated with therapy, the stakes are even higher.