Clinical

HCV treatment-related thrombocytopenia not helped by erythropoietin therapy

Last Updated: 2006-11-03 14:44:08 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Treatment with erythropoietin worsens thrombocytopenia induced by pegylated-interferon-alpha (IFN) therapy in patients with chronic hepatitis C (HCV) infection, Austrian researchers report in the October issue of the American Journal of Gastroenterology.

Dr. Markus Peck-Radosavljevik and colleagues at the Medical University of Vienna note that that the combination of IFN and ribavirin is the treatment of choice for hepatitis C. However, thrombocytopenia is a therapy-limiting side effect.

To determine whether erythropoietin treatment might help reduce this adverse effect, because it not only stimulates erythropoiesis but also thrombopoiesis, the researchers studied 40 patients. They were treated with INF and ribavirin and randomized to also receive 10,000 IU of erythropoietin or placebo 3 times weekly.

At the end of 4 weeks, erythropoietin was found to alleviate the decrease in hemoglobin (10% versus 20%). However, platelet counts decreased to a mean of 142 G/L in the erythropoietin group compared with 182 G/L in the placebo group.

Erythropoietin treatment also induced a 40% increase in protease activated receptor 1 (PAR-1) which is associated with platelet secretion and aggregation. In fact, there was a 100% increase in platelet reactivity.

"Surprisingly," Dr. Peck-Radosavljevik told Reuters Health, "erythropoietin treatment resulted in lower platelet counts compared to control, but this potentially negative effect on platelet plug formation was rescued by PAR-1 upregulation. Primary hemostasis remains intact in these patients even with reduced platelet counts."

Altogether, the researchers conclude that erythropoietin "is not a useful option for short-term support of platelet production during antiviral therapy."

Am J Gastroenterol 2006;101:2275-2282.