High‐dose vitamin E supplementation does not diminish ribavirin‐associated haemolysis in hepatitis C treatment with combination standard α‐interferon and ribavirin

Summary Background : Ribavirin is associated with haemolytic anaemia. Antioxidants have been reported to decrease severity of this anaemia. Aim : To determine effect of vitamin E supplementation on ribavirin‐associated haemolysis in chronic hepatitis C treated with standard α‐interferon and ribavirin. Methods : Fifty‐one naive chronic hepatitis C patients were randomized to receive either α‐interferon/ribavirin therapy (control) or therapy plus vitamin E 800 IU b.d. with 24‐week follow‐up. Alanine aminotransferase ALT, haemoglobin and reticulocyte percentage were monitored. Symptoms and health‐related quality of life were also monitored at each visit. Results : Forty‐seven subjects were treated (27 vitamin E /20 controls). Thirteen withdrew because of adverse effects or non‐compliance. Groups were similar in demographics, genotype and baseline lab indices. Comparison with baseline, treatment and follow‐up values showed a significant haemoglobin and ALT reduction in both groups. There was no significant difference in haemoglobin and reticulocyte percentage between groups. Sustained viral response was not significantly different between vitamin E (11/18) and control (6/16) groups. Three patients required ribavirin dose‐reduction in the vitamin E group compared with two controls. Health‐related quality of life during and end‐of‐treatment was not different between groups. Conclusions : Vitamin E supplementation alone during standard α‐interferon and ribavirin therapy does not appear to diminish ribavirin‐associated haemolysis.