Hepatitis C Management

Ask The Experts

Question:

In an HCV-infected patient with neutropenia who is receiving pegylated interferon and ribavirin, what is the recommended absolute neutrophil count (ANC) target range when treating with filgrastim (Neupogen)? At what ANC value should filgrastim therapy be initiated, and what is the suggested dosage?

The clinical implication of neutropenia during HCV therapy remains controversial. In one study of 119 HCV patients who were treated with the combination therapy, bacterial infections were not associated with severe neutropenia. The current recommended dose-reduction threshold for neutropenia is an ANC of less than 750. The safety and efficacy of filgrastim for managing interferon-related neutropenia in patients with HCV has not been established, and its use in this specific situation is not FDA-approved. Small-scale studies of filgrastim 300 µg weekly to 300 µg thrice weekly have suggested efficacy with relative safety.

Clinicians who decide to use filgrastim should carefully monitor white blood cell counts after filgrastim and should use the lowest effective dose.

For more information see the section on the management of side effects in the Hepatitis C Management monograph.