Anti-Oxidant vitamins delay anemia in combo treatment


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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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