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Hepatitis C Quicknotes: Rules for Adjusting Therapy for CBC Changes

for Health Care Providers

Antiviral TX Strategy

Rules For Adjusting Therapy According To CBC Changes

  1. Hgb 10-11 g/dL
    • Peginterferon.
      • Do not modify dosage
    • Ribavirin
      • If no or minimal symptoms, do not modify dosage
      • If symptomatic, decrease by 200 mg/day and/or consider erythropoietin, particularly if cirrhotic, posttransplant, or HIV/HCV coinfected
    • Candidates for Recombinant Erythropoietin Criteria for Use for Hepatitis C Treatment-Related Anemia
      • Rule out other causes of anemia
      • Anemia persists at 2 weeks after reducing ribavirin
      • No hypertension
    • Dosage:
      • Epoetin alfa 40,000 units SC/week
      • Darbepoetin alfa 200 mcg SC every other week
    • Goal:
      • Hemoglobin 12 g/dL
  2. Hgb 8.5-10 g/dL
    • Peginterferon
      • Do not modify dosage
    • Ribavirin
    • Candidates for erythropoietin
      • Rule out other causes of anemia
      • Anemia persists at 2 weeks after reducing ribavirin
      • No hypertension
    • Dosage:
      • Epoetin alfa 40,000 units SC weekly
      • Darbepoetin alfa 200 mcg SC every other week
    • Goal:
      • Hemoglobin 12 g/dL
  3. Hgb <8.5 g/dL
    • Peginterferon.
      • Do not modify dosage
    • Ribavirin
      • Discontinue until resolution
  4. WBC <1,500
    • Peginterferon alfa 2b
      • Reduce dosage by 50% and reevaluate
    • Ribavirin
      • Do not modify dosage
  5. WBC <1,000
    • Peginterferon alfa 2b
      • Discontinue until resolution
    • Ribavirin
      • Do not modify dosage
  6. ANC <750
    • Peginterferon
      • Reduce peginterferon alfa 2a dosage to 135 mcg/wekk and reevaluate
      • Reduce peginterferon alfa 2b dosage by 50% and reevaluate
    • Ribavirin
      • Do not modify dosage
  7. ANC <500
    • Peginterferon
      • Discontinue until resolution
    • Ribavirin
      • Do not modify dosage
    • Consider G-CSF in patients who are cirrhotic, posttransplant, or HIV/HCV coinfected, particularly if neutropenia persists despite peginterferon dosage reduction
  8. Platelets <80,000
    • Peginterferon
      • Reduce peginterferon alfa 2b dosage by 50% and reevaluate
    • Ribavirin
      • Do not modify dosage
  9. Platelets <50,000
    • Peginterferon
      • Reduce peginterferon alfa 2a dosage to 90 mcg/week and reevaluate
      • Discontinue peginterferon alfa 2b until resolution
    • Ribavirin
      • Do not modify dosage
  10. Platelets <25,000
    • Peginterferon
      • Discontinue until resolution
    • Ribavirin
      • Do not modify dosage

Next: Endpoints of HCV Therapy