459. Comparing Severity of Hematological Decline Across Various Hepatitis C Treatment Regimens
Session: Poster Abstract Session: Prevention and Treatment of Viral Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Hematological adverse effects are common across various hepatitis C treatment regimens. The aim of our study was to compare the severity and rate of hematological decline in patients who received the two drug regimen (pegylated interferon alpha-2a and ribavirin) versus those who receive the newer NS3/4A protease inhibitors (boceprevir and telepravir) in addition to the two drug regimen.

Methods: Data analysis was done for 26 patient who had completed or terminated therapy either with boceprevir (n=11) or telaprevir (n=15) in combination with pegylated interferon alpha-2a and ribavirin. These data were compared with patients who had received the two drug regimen (n=54). Severity of hematological decline was calculated as the absolute and percentage drop in hematological indices comparing the baseline and nadir values. Various hematological indices were compared across groups.

Results: The decline in hemoglobin, white blood cells, absolute neutrophil cells and platelets were significantly greater in triple drug regimen group. These decline were observed significantly earlier among patients on triple drug regimen (see table below). There was no statistical difference in severity of hematological decline among patients on triple drug regimen between the boceprevir and teleprevir group.

Conclusion: Our data confirms that patients on triple drug regimen for hepatitis C have much severe hematological decline and at a faster rate as compared to the historic two drug regimen. This could lead to higher rates of treatment discontinuation during the early phase of treatment and increase the occurrence of treatment failure.

 

 

Triple drug regimen

Two drug regimen

p value

N = 26

N = 54

 

Mean ± SEM

Mean ± SEM

 

Hemoglobin

 

 

 

Absolute drop (gm/dl)

4.3 ± 0.6

2.4 ± 0.5

<0.01

Percentage drop (%)

30.4 ± 4.2

17.7 ± 3.7

<0.01

Weeks to nadir value

12 ± 2.8

23.1 ± 3.4

<0.01

White blood count

 

 

 

Absolute drop (cells/cumm)

4000 ± 800

2600 ± 800

0.02

Percentage drop (%)

60.3 ± 5.7

39.2 ± 6.3

<0.01

Weeks to nadir value

11.7 ± 2.5

24.3 ± 3.6

<0.01

Absolute neutrophil count

 

 

 

Absolute drop (cells/cumm)

2500 ± 600

1300 ± 500

<0.01

Percentage drop (%)

66 ± 6.7

39.3 ± 8.2

<0.01

Weeks to nadir value

11.4 ± 2.5

19.7 ± 4.1

0.01

Platelet count

 

 

 

Absolute drop (cells/cumm)

96,700 ± 20,000

52,200 ± 12,700

<0.01

Percentage drop (%)

46.2 ± 6.4

27.6 ± 12.7

<0.01

Weeks to nadir value

13.2 ± 2.9

18.9 ± 3.4

0.04

Lokesh Shahani, MD, MPH1, Vikas Jogi, MD1, Isha Tyagi, MD1, Vidya Sundareshan, MD, MPH1, Shingo Chihara, MD1, Amardeep Shreshtha1, Swapna Devanna1, Dheeraj Reddy1, Srivalli Vegi, MD1, Jennifer Andoh1, Scott Bergman, Pharm, D2 and Janak Koirala, MD1, (1)Southern Illinois University School of Medicine, Springfield, IL, (2)Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, IL

Disclosures:

L. Shahani, None

V. Jogi, None

I. Tyagi, None

V. Sundareshan, None

S. Chihara, None

A. Shreshtha, None

S. Devanna, None

D. Reddy, None

S. Vegi, None

J. Andoh, None

S. Bergman, None

J. Koirala, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.