Impact of Pentoxifylline and Vitamin E on Ribavirin-induced
Hemolytic Anemia in Chronic Hepatitis C Patients:
An Egyptian Survey
Mehdat Assem, M Yousri
Citation Information :
Assem M, Yousri M. Impact of Pentoxifylline and Vitamin E on Ribavirin-induced Hemolytic Anemia in Chronic Hepatitis C Patients: An Egyptian Survey. Euroasian J Hepatogastroenterol 2012; 2 (1):35-40.
Background: The present study aimed to elucidate the impact
of combined pentoxifylline and high-dose vitamin E
supplementation on Ribavirin (RBV)-induced hemolytic anemia
in patients with chronic hepatitis C (CHC).
Patients and methods: A total of 200 treatment-naïve chronic
CHC patients were randomized into two groups to receive either
the standard antiviral therapy and pentoxifylline (800 mg) and
high-dose vitamin E (1000 IU) daily (combined group) or
standard antiviral therapy and placebo (control group). They
were followed-up to assess occurrence of anemia and virological
responses respectively.
Results: Dose modification of RBV due to anemia was
significantly lower in combined group (8.5%) compared to control
group (21.5%) (p < 0.05). Withdrawal from therapy due to severe
anemia (Hb < 8.5 gm/dl) was recorded only in six (28.6%)
patients of the control group. Both end of treatment response
(ETR) and sustained virological response (SVR) were significantly
higher in combined group compared to control (p < 0.05).
Conclusion: Pentoxifylline and vitamin E can ameliorate RBVassociated
hemolysis; improve compliance and virologic
clearance, when combined with the standard antiviral therapy
in patients with CHC.
Williams R. Global challenges in liver disease. Hepatology 2006;44:521-26
Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 2005;5:558-67
Hepatitis C genotype 4: What we know and what we do not yet know? Hepatology 2008;47:1371-83. 40 JAYPEE Mehdat Assem, M Yousri 4. Ray SC, Arthur RR, Carella A, et al. Genetic epidemiology of hepatitis C virus throughout Egypt. J Infect Dis 2000;182: 698-707
PEGASYS International Study Group. Peginterferon-alpha 2a and ribavirin combination therapy in chronic hepatitis C: A randomized study of treatment duration and ribavirin dose. Ann Intern Med 2004;140:346-55
Haemolytic anaemia induced by ribavirin therapy in patients with chronic hepatitis C virus infection: Role of membrane oxidative damage. Hepatology 2000;31:997-1010
Ribavirininduced anaemia: Mechanisms, risk factors and related targets for future research. Curr Med Chem 2006;13:3351-57
Peginterferon alpha 2a and ribavirin combination therapy in chronic hepatitis C: A randomized study of treatment duration and ribavirin dose. Ann Intern Med 2004;140:346-55
Effect of pentoxifylline on the evolution of diabetic nephropathy. Med Clin (Barc) 2009;132:772-78
Effect of pentoxifylline on inflammatory burden, oxidative stress and platelet aggregability in hypertensive type 2 diabetes mellitus patients. Vascul Pharmacol 2007;47:118-24
Beneficial effects of tumour necrosis factor-alpha inhibition by pentoxifylline on clinical, biochemical, and metabolic parameters of patients with non-alcoholic steatohepatitis. Am J Gastroenterol 2004; 99: 1946-52
Pentoxifylline down regulates profibrogenic cytokines and procollagen I expression in rat secondary biliary fibrosis. Gut 2002;50:241-47
Non-alcoholic steatohepatitis and insulin resistance: Interface between gastroenterologists and endocrinologists. Acta Clin Belg 2003;58:81-91
Insulin resistance in patients with steatohepatitis. Hepatogastroenterology 2003;50:456-59
(Accesse june 14, 2010, at: www. hcvadvocate.org/hepatitis/factsheets_pdf 17. Luca C, Grigore L, Vâþã A, et al. Adverse reactions of different treatments in chronic hepatitis C. Rev Med Chir Soc Med Nat Iasi 2009; 113:991-95
Predictors of response to chronic hepatitis C treatment. Ann Hepatol 2010;9 Suppl:54-60
High-dose vitamins E and C supplementation prevents ribavirin-induced haemolytic anaemia in patients with chronic hepatitis C. Hepatol Res 2007;37:317-24
High-dose vitamin E supplementation does not diminish ribavirin-associated haemolysis in hepatitis C treatment with combination standard alpha-interferon and ribavirin. Aliment Pharmacol Ther. 2004;20:1189-93
The effect of pentoxifylline on filterability of normal red blood cells and their adhesiveness to cultured endothelial cells. Eur J Clin Pharmacol 1985;29:55-59
Treatment of homozygous sickle cell disease with pentoxifylline. J Natl Med Assoc 1999;91:466-70
Effect of pentoxifylline on levels of pro-inflammatory cytokines during chronic hepatitis C. Scand J Immunol 2006;63:461-67
Strategies for managing anaemia in hepatitis C patients undergoing antiviral therapy. Am J Gastroenterol 2007;102:880-89.