IngentaConnect Erythropoietin Treatment Is Associated with More Severe Thrombocy...

Authors: Homoncik, Monika¹; Sieghart, Wolfgang²; Formann, Elisabeth¹; Schmid, Monika¹; Ferenci, Peter¹; Gangl, Alfred¹; Jilma, Bernd²; Peck-Radosavljevic, Markus¹

Source: The American Journal of Gastroenterology, Volume 101, Number 10, October 2006 , pp. 2275-2282(8)

Publisher: Blackwell Publishing

Abstract:

BACKGROUND: Erythropoietin (EPO) not only stimulates erythropoiesis but also thrombopoiesis. As pegylated-interferon-α(PEG-IFN-α)-induced thrombocytopenia may become a limiting factor for continuation of therapy, the present study investigated if EPO can alleviate PEG-IFN-α induced thrombocytopenia. Further, we hypothesize that EPO increases platelet reactivity and protease activated receptor 1 (PAR-1) expression during combination antiviral therapy.

METHODS: Forty patients with chronic hepatitis C received either 10,000 IU EPO 3×/week or placebo in a randomized, placebo-controlled, double-blinded fashion for 4 wk and combination antiviral therapy with PEG-IFN-2a and ribavirin.

RESULTS: EPO alleviated the decrease in hemoglobin during combination antiviral therapy with ribavirin (10%vs 20%, p < 0.0001). Platelet counts decreased stronger in EPO than in placebo group on day 28 (p= 0.007). EPO induced a 40% increase in PAR-1 (p < 0.0001), which was accompanied by 100% increase in platelet reactivity (p < 0.0001). PFA-100 platelet plug formation time and PEG-IFN-α-induced vWF-increase were not different between study groups.

CONCLUSIONS: Treatment with EPO alleviated the decrease in hemoglobin but worsened PEG-IFN-α induced thrombocytopenia after the first 4 wk of combination therapy. EPO caused PAR-1 receptor upregulation on platelets, which promoted an increase in platelet reactivity without affecting PFA-100 platelet plug formation time. EPO is not a useful option for short-term support of platelet production during antiviral therapy.

(Am J Gastroenterol 2006;101:2275-2282)

Document Type: Research article

DOI: 10.1111/j.1572-0241.2006.00774.x

Affiliations: 1: Department of Internal Medicine IV, Division of Gastroenterology, and Hepatology 2: Department of Clinical Pharmacology, Medical University, Vienna, Austria

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Erythropoietin Treatment Is Associated with More Severe Thrombocytopenia in Patients with Chronic Hepatitis C Undergoing Antiviral Therapy