an index to predict ribavirin-induced anemia in asian patients with chronic genotype 1 hepatitis c

Background: single-nucleotide polymorphisms (snp) in the inosine triphosphate pyrophosphatase (itpa) gene correlate with ribavirin (rbv)-induced anemia in patients with chronic hepatitis c (chc) receiving combination therapy. managing anemia is an early priority in the treatment process. objectives: the aim was to develop a predictive index based on itpa snp status to identify chc patients at risk of anemia. patients and methods: a total of 418 eligible east asian patients diagnosed with chc genotype 1 (g1) received combination therapy in this study. participant dna was genotyped for a functional itpa snp (c/c, a/a or c/a) on chromosome 20 at rs1127354. a predictive index was constructed by incorporating independent factors identified for severe anemia events (hemoglobin < 10 g/dl). areas under the receiver- operating characteristic curves (aucs) represented the diagnostic accuracies of the predictive index in randomly assigned development and validation cohorts. results: multiple logistic regressions identified age (≥ 50 y: or = 9.7, 95% ci = 5.0 - 18.6), itpa rs1127354 (c/c: or = 3.3, 95% ci = 1.8 - 5.8) and baseline hemoglobin (< 14.0 g/dl: or 6.4, 95% ci = 3.3 - 12.1; 14.0 - 14.9: or = 2.4, 95% ci = 1.2 - 4.6) as predictors of severe anemia throughout the treatment. for severe anemia, the predictive index incorporating age, itpa snp status and baseline hemoglobin yielded diagnostic accuracies (aucs) of 0.830 (95% ci = 0.783 - 0.871) in the development (n = 324) and 0.902 (0.826 - 0.925) in the validation (n = 81) cohorts. conclusions: in patients with chc g1 and receiving combination therapy, itpa snp-based index was an accurate and practical solution for prediction of severe anemia.