The approval of ribavirin for reimbursement under the health insurance scheme in Japan in 2001 started a new era in interferon (IFN) therapy against chronic hepatitis C, enabling a change from IFN mono therapy to combination therapy with IFN and ribavirin. As the major safety problems of ribavirin, teratogenicity, hemolytic anemia and skin symptoms may be given. Also, there is known to be a greater incidence of decreased hemoglobin (Hb) in combination therapy with IFN α-2b and ribavirin than in the case of IFN mono therapy. Despite this, however, it has been considered that combination therapy may be accomplished if the criteria for reducing the dosage of ribavirin are strictly followed.
In this study, patients receiving combination therapy with IFN α-2b and ribavirin in Osaka National Hospital were followed up to evaluate the decrease in Hb in cases in which the ribavirin was reduced in dosage or discontinued (reduced/ discontinued group). Hb levels in this group decreased by 3.0± 1.6 g/dL on average after 4 weeks, significantly lower than pretreatment levels. In these subjects, it seemed that the decreased Hb levels after 4 weeks of the combination therapy aggravated anemia symptoms and subjective symptoms such as general fatigue, with the result that combination therapy could not be accomplished.
