NEW APPROACHES TO OPTIMIZING ANTIVIRAL THERAPY IN PATIENTS WITH CHRONIC HEPATITIS C AND LOW BASELINE LEUKOCYTE CONTENT

Objective. To study the effect of dicarbamin on the efficiency of antiviral therapy in patients with chronic hepatitis C (CHC) virus genotype 1b and decreased baseline leukocyte and neutrophil levels. Subjects and methods. Eighty-six patients were followed up, who were divided into 2 sex- and age-matched groups according to treatment regimens: Group 1 (n = 44) took pegylated interferon-a-2b (PegIFN-a-2b) + ribavirin; Group 2 (n = 42) received PegIFN-a-2b + ribavirin + dicarbamin. PegIFN-a-2b was injected subcutaneously in a dose of 100 μg once weekly, ribavirin was given in a dose of 1000 mg/day weekly as a 48-week course. In accordance with randomization (by the envelope method), dicarbamin was used in a dose of 100 mg once daily as a 9-weeks course following initiation of antiviral therapy, then 9 weeks before its termination. Results. It was found that the use of PegIFN-a-2b in combination with ribavirin (Group 1) caused a significantly more pronounced decrease in the indicators examined than in the group receiving dicarbamin (Group 2). Thus, in Group 1, the minimal level of leukocytes was 2.1 ± 0.16х10 9/1 and that of neutrophils was 1.0 ± 0.03 х 10 9/l whereas in Group 2, these were 3.4 ± 0.11 х 10 9/l and 1.9 ± 0.05х 10 9/l, respectively (p < 0.05). The analysis showed significantly better treatment results in Group 2 than in Group 1 (p < 0.05). It can be inferred that dicarbamin may potentiate an antiviral effect if incorporated in combination antiviral therapy. This emergent property of the drug was recorded when the long-term results of treatment were studied (a sustained virologic response was achieved). Conclusion. The use of dicarbamin in combination with PegIFN-a-2b and ribavirin in patients with CHC virus genotype 1b and leuko- and neutropenia at the start of therapy permits the treatment to be performed without dose reduction and PegIFN-a-2b discontinuation as there was no critical reduction in the levels of leukocytes and neutrophils. Incorporation of dicarbamin in combination antiviral therapy caused a rise in the rate of a sustained virologic response in patients with CHC, which increased the efficiency of treatment by 20.7%.

chronic hepatitis C, antiviral therapy, dicarbamin, neutropenia, leukopenia