Granulocyte colony-stimulating factor dosing in pegylated interferon alpha-induced neutropenia and its impact on outcome of anti-HCV therapy

Many patients with chronic hepatitis C (HCV) infection undergoing treatment with pegylated interferon‐alpha (PEG‐IFN‐alpha) and ribavirin develop neutropenia requiring dose reduction or granulocyte colony‐stimulating factor (G‐CSF) supplement. We analysed the database of patients who completed treatment for chronic HCV infection between 2003 and 2006. Patients with absolute neutrophil counts below 1000 cells/μL were initiated on G‐CSF (G‐CSF group) while a matching group of patients who received anti‐HCV treatment without developing neutropenia were used as a control group (non‐G‐CSF group). Patients on the G‐CSF arm were divided into two subgroups based on the timing of G‐CSF administration relative to PEG‐IFN‐alpha administration. Of the 163 patients with HCV infection, 30 patients received G‐CSF, most of who were maintained on 300 μg of G‐CSF once a week. Administration of G‐CSF 2 days before or after each dose of PEG‐IFN‐alpha did not make a significant difference in the neutrophil counts. In the G‐CSF arm, 23 of 30 patients (77%) had undetectable end‐of‐treatment viral response which was comparable with 27 of 30 in the control group (90%; P = 0.17). There was no statistically significant difference in the sustained viral response between the two groups (61%vs 76%, P = 0.18). In most patients PEG‐IFN‐alpha induced neutropenia improved with a once‐a‐week dose of G‐CSF with a comparable virological outcome. Timing of G‐CSF administration did not make any significant impact on the patient's neutrophil counts but was better tolerated when given 2 days apart from PEG‐IFN‐alpha.