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Table 5. General guidelines for PegIFN-RBV dose reduction or discontinuation

for Health Care Providers

Table 5. General guidelines for PegIFN-RBV dose reduction or discontinuation (32,33,57,58)

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PegIFN dose recommendationa

ANC, absolute neutrophil count; BOC, boceprevir; GCSF, granulocyte colony-stimulating factor; Hb, hemoglobin; HCV, hepatitis C virus; PegIFN, peginterferon; RBV, ribavirin; TVR, telaprevir; WBC, white blood cell counts.

a Manufacturer package insert recommendations.

b If dose is maintained outside of manufacturer recommendations, monitor ANC more frequently, and counsel patient on neutropenic precautions. In post-liver transplantation or HIV/HCV-coinfected patients who remain neutropenic despite dose reduction, consider starting GCSF until resolution.

c If dose is maintained outside of manufacturer recommendations, monitor platelet counts, and signs or symptoms of unusual bleeding or bruising more frequently.

WBC
<1.5 x 109/l PegIFN alfa-2b: reduce dose to 1 mcg/kg per week,
then to 0.5 mcg/kg per week if needed
<1.0 x 109/l Discontinue PegIFN alfa-2b until resolution
ANCb
<0.75 x 109/lPegIFN alfa-2a: reduce dose to 135 mcg per week
PegIFN alfa-2b: reduce dose to 1 mcg/kg per week,
then to 0.5 mcg/kg per week if needed
<0.50 x 109/l Discontinue PegIFN until resolution
Plateletsc
<50 k/mm3PegIFN alfa-2a: reduce dose to 90 mcg per week
PegIFN alfa-2b: reduce dose to 1 mcg/kg per week,
then to 0.5 mcg/kg per week if needed
<25 k/mm3Discontinue PegIFN until resolution
RBV dose recommendation
Hb
<11.0, but >10 g/dl No change in RBV dose if patient has minimal symptoms
In a symptomatic patient, consider RBV dose reduction
<10.0, but >8.5 g/dl Decrease RBV, consider starting an erythropoietic growth factor
In patients with a cardiac history, reduce RBV dose and reduce PegIFN alfa-2b dose by 50%
<8.5 g/dl Discontinue RBV until resolution
If RBV is stopped for ≥ 7 days or discontinued in patients who are concomitantly receiving BOC or TVR, then BOC or TVR must be permanently discontinued