Ribavirin Impairs Salivary gland function During Combination Treatment With Pegylated Interferon Alfa-2a In HEpatitis C patients

摘要

Background: Xerostomia is a common adverse event of unknown etiology observed during pegylated interferon (PegIFN)/Ribavirin (Rbv) treatment. Objectives: To assess the frequency and mechanisms of xerostomia during PegIFN/Rbv therapy. Patients and Methods: Thirty-one na?ve patients with chronic hepatitis C consecutively received PegIFN-α2a (180 μg/week) plus Rbv (800-1200 mg/day). The controls were 10 patients with chronic hepatitis B who received PegIFN-α2a (180 μg/week). During treatment and follow-up, all patients underwent basal and masticatory stimulated sialometry, otorhinolaryngoiatric (ORL) examination, and a questionnaire survey to subjectively assess symptoms of oral dryness. Results: Twenty-seven patients on PegIFN/Rbv and 4 on PegIFN (87% vs. 40%, P = 0.006) reported xerostomia. Thirty patients on PegIFN/Rbv combination therapy and 2 patients on monotherapy had ORL signs of salivary gland hypofunction (97% vs. 20%, P < 0.0001). Mean basal (A) and stimulated (B) salivary flow rates (mL/min) progressively decreased during PegIFN/Rbv treatment (A, 0.49 at baseline vs. 0.17 at the end of treatment, P < 0.0001; B, 1.24 at baseline vs. 0.53 at the end of treatment, P = 0.0004). At week 24 following PegIFN/Rbv treatment, salivary flow rates were similar to baseline (A, 0.53 at the end of follow-up vs. 0.49 at baseline; B, 1.19 at the end of follow-up vs. 1.24 at baseline). Salivary function was unaffected in monotherapy patients. Conclusions: Rbv causes salivary gland hypofunction in hepatitis C patients receiving PegIFN/Rbv therapy, which promptly reverts to normal upon cessation of treatment. Implication for health policy/practice/research/medical education: The implications of the present study can be useful to correctly manage the side effects of Ribavirin. Indeed Ribavirin is not only a key player of the current standard of care regimen for chronic hepatitis C, but will also remain crucial for achieving optimal sustained virological response rates once the first and second generation of directly acting antiviral agents become available worldwide. Please cite this paper as: Aghemo A, Rumi MG, Monico S, Banderali M, Russo A, Ottaviani F, et al. Ribavirin Impairs Salivary Gland Function in Hepatitis C Patients During Combination Treatment With Pegylated Interferon Alfa-2a. Hepat Mon. 2011; 11(11):918-24.DOI:10.5812/kowsar.1735143X.733.