Anti-Oxidant Vitamins Delay Ribavirin-Related Anemia in Patients
on Combination Therapy
Patients on combination therapy who took the antioxidant
vitamins C and E delayed the onset of anemia. Hemolytic anemia is a
serious side effect of combination therapy, attributable to the
ribavirin component in the combination. This complication
necessitates a reduction in the ribavirin dose for about 15% of all
patients, according to Edward Piken, M.D., Director of Research at
South Bay Gastroenterology in Torrance, California.
"Patients become anemic: they feel short of breath, become
weaker, are unable to do their normal workload," Dr. Piken says.
One hypothesis is that ribavirin accumulates in red blood cells.
"The red cells, because of the medications, are under what's called
an oxidative stress, and the red cells break down at an earlier
point in their life cycle."
To investigate a solution to this problem, Dr. Piken enrolled 12
previously untreated HCV patients in a study to look at the effects
of antioxidant vitamins on anemia. Patients received 1,200
milligrams of ribavirin daily along with 3 million units of
interferon alfa-2b three times a week. They also took two common
over the counter vitamins daily - 1000 milligrams of vitamin C and
800 IU (international units) of vitamin E. "We chose them because
they have essentially no side effects, and many people are already
taking them," Dr. Piken says. Results were compared to a control
group of 14 relapse patients who received combination therapy
without any antioxidants.
According to Dr. Piken, patients receiving the antioxidants
showed an initial benefit from the vitamins, but that benefit
declined by the end of three months of treatment. The antioxidants
"appear to delay the onset and severity of the anemia, and patients
receiving antioxidants do not require [ribavirin] dose reductions,
compared to 22% of the people in the control group," he says.
Dr. Piken says the results merit further research. "We plan to
run a larger study and also are currently making a decision on
which type of antioxidant to use," he says. "We would like to use
more bio-available and perhaps stronger antioxidants. The forms of
the vitamins, particularly C, could be improved to a more
bio-available vitamin C."
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