November 2003: Case Study 2

DC, a pharmacy student currently on an infectious disease rotation, is asked to review the laboratory reports for the clinic patients. The 5 patients seen in the clinic today are infected with the hepatitis C virus and are receiving treatment with peginterferon alfa-2b and ribavirin. The unusual lab values for these 5 patients include the following:

Patient 1 Hgb 9.5 g/dL

Patient 2 Hgb 8.0 g/dL

Patient 3 WBC 1.4 x 109/L

Patient 4 Platelets 70 x 109/L

Patient 5 Platelets 40 x 109/L

The attending physician explains to DC that peginterferon and ribavirin must be dose-modified or discontinued based on hemoglobin, WBC (white blood count), neutrophil, and platelet values. He then asks DC to make recommendations pertaining to the patients? peginterferon and ribavirin.

What recommendations should DC make pertaining to each patient?s therapy?

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The manufacturer recommends the following dose modifications due to hematologic toxicity:

Laboratory Values

Peginterferon

Ribavirin

Hgb <10.0 g/dL

NA

Decrease by 200 mg/day

Hgb <8.5 g/dL

Discontinue

Discontinue

WBC <1.5 x 109/L

Decrease dose by 50%

NA

WBC <1.0 x 109/L

Discontinue

Discontinue

Neutrophils <0.75 x 109/L

Decrease dose by 50%

NA

Neutrophils <0.5 x 109/L

Discontinue

Discontinue

Platelets <80 x 109/L

Decrease dose by 50%

NA

Platelets <50 x 109/L

Discontinue

Discontinue

The recommended adjustments for these 5 patients are:

Patient 1 Decrease ribavirin dose by 200 mg/day

Patient 2 Discontinue peginterferon and ribavirin permanently

Patient 3 Reduce peginterferon dose by 50%

Patient 4 Reduce peginterferon dose by 50%

Patient 5 Discontinue peginterferon and ribavirin permanently

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