Z Gastroenterol 2012; 50 - K059
DOI: 10.1055/s-0032-1323994

Age-dependent rise in early Hemoglobin (Hb) decline contributes to a higher frequency of anemia in elder patients treated with peginterferon alfa-2b (Peg2b)/Ribavirin (RBV) for chronic HCV Genotype 1 (G1) infection

G Teuber 1, S Mauss 2, D Hueppe 3, E Zehnter 4, MP Manns 5, T Dahhan 6, U Meyer 7, T Witthoeft 8, B Moeller 7, N Dikopoulos 9, J Brack 10, D Hartmann 11 M Bilzer 11, the bng hepatitis study group
  • 1Johann Wolfgang Goethe University, Medizinische Klinik II, Frankfurt, Germany
  • 2Medical Group Practice, Düsseldorf, Germany
  • 3Medical Group Practice, Herne, Germany
  • 4Gastroenterological Practice, Dortmund, Germany
  • 5Medical High School Hannover, Hannover, Germany
  • 6Medical Practice, Fellbach, Germany
  • 7Medical Practice, Berlin, Germany
  • 8Gastroenterologische Facharztpraxis, Stade, Germany
  • 9Gesundheitszentrum Langenau, Langenau, Germany
  • 10Hospital Nord Ochsenzoll, Hamburg, Germany
  • 11MSD Pharma GmbH, Haar, Germany

Aims: Treatment of chronic hepatitis C with peginterferon/RBV is frequently complicated by anemia. Age older than 50 years and female gender are factors that increase the risk of anemia. We here investigated how these factors influence the incidence and onset of anemia.

Methods: Data of patients treated for G1 infection within the German Peg2b/RBV observational study were retrospectively analyzed. In this real-life cohort study G1 infection was treated with Peg2b 1.5µg/kg/wk+weight-based RBV (800–1200mg/day) for up to 48 wks at 285 sites. Patients who discontinued for non-response or for any other reasons were included in the analysis. SVR was defined as undetectable serum HCV-RNA 24 wks after EOT response. Only one patient received erythropoietin treatment for anemia.

Results: 1890 patients had at least one Hb measurement during therapy. Anemia, defined as serum hemoglobin <10g/dL at any time during treatment, occurred in 373 (19.7%) patients with a higher frequency in females compared to males (27.3% vs. 14.0%; p<0.0001). With growing age baseline Hb levels remained stable but the rate of anemia increased with a shift from late to early anemia in females in contrast to an increase of both, early and late anemia, in males. Early onset of anemia at or before week 8 was associated with poor SVR rates in female (40.0%, 40/100) and male patients (25.9%, 15/58) in contrast to significantly higher SVR rates of 64.2% (79/123; p=0.0292) and 43.5% (40/92; p=0.0003) after late onset of anemia (>8 weeks). The increase in the rate of early anemia in the elder population was caused by a stronger Hb decline as indicated by the higher proportion of patients with Hb decline >3g/dl at any time during treatment as well as in treatment week 4 (TW4). Compared to female patients, a significantly higher proportion of male patients showed an early Hb decline >3g/dl in TW4 despite lower or equal dosages of RBV and Peg2b at the start of treatment.

Conclusions: Despite a stronger Hb decline during Peg2b/RBV treatment of male patients anemia occurs less frequent due to higher baseline Hb levels compared to female patients. Growing age is associated with a continuous rise in initial Hb decline contributing to the higher frequency of anemia in elder patients.