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Altraif IH, Sanai F, Babatin MA, Alalwan AA, Abdo AA, Alhamoudi W, Peedikayil M, Alghamdi H, Alsohaibani F, Alswat KA, Murtaza S, Alghamdi A, Altraif S, Aljumah A, Handoo FA, AlBekairy AM, Al-Ashgar HI, Alquaiz M, Alblawi MA, AlTamimi W, Loustaud-Ratti V, Marquett P. Pharmacokinetics-Based Adjusted Versus Standard Dose of Ribavirin Does Not Improve Virologic Response Rates in Chronic Hepatitis C Genotype 4 Patients: A Randomized Controlled Trial. J Interferon Cytokine Res 2018; 37:488-493. [PMID: 29135370 DOI: 10.1089/jir.2017.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Optimal doses of Ribavirin (RBV) for hepatitis C virus (HCV) treatment are not known. To assess the safety and efficacy of PegIFNalfa-2a in combination with an adjusted (ADJ) RBV dose based on early pharmacokinetics versus a fixed standard (STD) dose of RBV in chronic HCV genotype (GT) 4-naive patients in a randomized trial. One hundred eighty-one patients were randomized. The baseline variables were similar in both arms and females were 50.3% of the patients, 76.5% had minimal-moderate fibrosis (F0-2). Sustained virologic response (SVR) was achieved in 99 (54.7%) subjects. SVR was seen in 50/90 (55.6%) of ADJ dose of RBV and 49/91 (53.9%) of STD dose subjects. Prematurely withdrawal or discontinuation of treatment prematurely in the ADJ RBV arm occurred in 11/90 patients (12.2%) compared with 6/91 subjects (6.6%) in the STD arm (P = 0.214). Similarly, virologic relapse was seen in 14/90 (15.6%) patients of the ADJ arm and 12/91 (13.2%) of the STD arm. Anemia grade 3-4 was seen in 36.7% in ADJ versus 17.6% in STD arm (P = 0.003). Occurrence of rapid virologic response and absences of F4 fibrosis predicted SVR in a univariate analysis. However, age, gender, weight, presence of diabetes, baseline alanine aminotransferase, and vitamin D levels were not significantly different in patients achieving SVR. ADJ higher doses of RBV based on its early pharmacokinetics-based RBV do not improve SVR rates in HCV GT4 treated in combination with peg-IFN alpha-2-a versus STD therapy. Patients on ADJ higher doses of RBV experienced higher rates of anemia and require more erythropoietin without increasing SVR.
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Affiliation(s)
- Ibrahim H Altraif
- 1 Division of Hepatology, Department of Organ Transplant and Hepatobiliary Sciences, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Faisal Sanai
- 2 Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City , Jeddah, Saudi Arabia
| | - Mohammed A Babatin
- 3 Gastroenterology Unit, Department of Medicine, King Fahad General Hospital , Jeddah, Saudi Arabia
| | - Abduljaleel A Alalwan
- 1 Division of Hepatology, Department of Organ Transplant and Hepatobiliary Sciences, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Ayman A Abdo
- 4 Liver Disease Research Center, College of Medicine, King Saud University , Riyadh, Saudi Arabia
| | - Waleed Alhamoudi
- 4 Liver Disease Research Center, College of Medicine, King Saud University , Riyadh, Saudi Arabia
| | - Musthafa Peedikayil
- 5 Gastroenterology Section, Department of Medicine, King Faisal Specialist Hospital and Research Center , Riyadh, Saudi Arabia
| | - Hamdan Alghamdi
- 1 Division of Hepatology, Department of Organ Transplant and Hepatobiliary Sciences, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Fahad Alsohaibani
- 5 Gastroenterology Section, Department of Medicine, King Faisal Specialist Hospital and Research Center , Riyadh, Saudi Arabia
| | - Khalid A Alswat
- 4 Liver Disease Research Center, College of Medicine, King Saud University , Riyadh, Saudi Arabia
| | - Shazia Murtaza
- 1 Division of Hepatology, Department of Organ Transplant and Hepatobiliary Sciences, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Abdullah Alghamdi
- 3 Gastroenterology Unit, Department of Medicine, King Fahad General Hospital , Jeddah, Saudi Arabia
| | - Sara Altraif
- 1 Division of Hepatology, Department of Organ Transplant and Hepatobiliary Sciences, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Abdulrahman Aljumah
- 1 Division of Hepatology, Department of Organ Transplant and Hepatobiliary Sciences, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Fayaz A Handoo
- 1 Division of Hepatology, Department of Organ Transplant and Hepatobiliary Sciences, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Abdulkareem M AlBekairy
- 6 Department of Pharmaceutical Care, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Hamad I Al-Ashgar
- 7 Gastroenterology Section, Department of Medicine, King Faisal Specialist Hospital and Research Center, Alfaisal University , Riyadh, Saudi Arabia
| | - Mohammed Alquaiz
- 5 Gastroenterology Section, Department of Medicine, King Faisal Specialist Hospital and Research Center , Riyadh, Saudi Arabia
| | - Mohammed A Alblawi
- 8 Department of Pathology and Laboratory Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | - Waleed AlTamimi
- 8 Department of Pathology and Laboratory Medicine, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud Bin Abdulaziz University for Health Sciences , Riyadh, Saudi Arabia
| | | | - Pierre Marquett
- 10 Department of Pharmacology and Toxicology, CHU Limoges , Limoges, France
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Handala L, Domange B, Ouled-Haddou H, Garçon L, Nguyen-Khac E, Helle F, Bodeau S, Duverlie G, Brochot E. DHEA prevents ribavirin-induced anemia via inhibition of glucose-6-phosphate dehydrogenase. Antiviral Res 2017; 146:153-160. [PMID: 28890388 DOI: 10.1016/j.antiviral.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 12/29/2022]
Abstract
Ribavirin has been widely used for antiviral therapy. Unfortunately, ribavirin-induced anemia is often a cause of limiting or interrupting treatment. Our team has observed that dehydroepiandrosterone (DHEA) has a protective effect against in vitro and in vivo ribavirin-induced hemolysis. The aim of this study was to better understand this effect as well as the underlying mechanism(s). DHEA was able to reduce in vitro intraerythrocytic ATP depletion induced by ribavirin. Only 1% of ATP remained after incubation with ribavirin (2 mM) at 37 °C for 24 h vs. 37% if DHEA (200 μM) was added (p < 0.01). DHEA also helped erythrocytes conserve their size, with a shrinkage of only 10% vs 40% at 24 h with ribavirin alone (p < 0.01), and reduced phosphatidylserine exposure at the outer membrane, i.e. 27% vs 40% at 48 h, (p < 0.05). DHEA also inhibits ribavirin-induced hemolysis, i.e. 34% vs 46.5% at 72 h (p < 0.01). DHEA is an inhibitor of glucose-6-phosphate dehydrogenase (G6PD), a key enzyme in the hexose monophosphate shunt connected to the glycolytic pathway which is the only energy supplier of the red blood cell in the form of ATP. We have confirmed this inhibitory effect in the presence of ribavirin. All these observations suggest that ribavirin-induced hemolysis was initiated by ATP depletion, and that the inhibitory effect of DHEA on G6PD was able to rescue enough ATP to limit this hemolysis. This mechanism could be important for improving the therapeutic management of patients treated with ribavirin.
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Affiliation(s)
- Lynda Handala
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Barbara Domange
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Hakim Ouled-Haddou
- Laboratoire d'Hématologie EA4666, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Loïc Garçon
- Laboratoire d'Hématologie EA4666, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Eric Nguyen-Khac
- Service d'Hépato-Gastroentérologie, ERI24, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Francois Helle
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Sandra Bodeau
- Laboratoire de Pharmacologie-Toxicologie, U1088, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Gilles Duverlie
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Etienne Brochot
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France.
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