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Commentary: real‐world triple therapy experience treating hepatitis C virus – authors' reply

We thank Heron and colleagues for their interest in our report 2 and agree that the cost-effectiveness of this therapy is called into question by the number of patients who are unable to complete treatment and successfully achieve sustained virological response. We are analysing the cost-effectiveness of this regimen using real-world data. Ribavirin dose reduction during treatment was not recorded in more than 50% of our patients. As decisions on adverse event management were at the discretion of individual clinicians, anaemia management varied. Several patients received erythropoietin (EPO) therapy prior to ribavirin dose reduction, and some had signs of severe anaemia at the first or second visit and required blood transfusion before dose reduction might have been possible. Thus, great importance must be placed on careful patient monitoring when using these medications. With some exceptions, ribavirin dose was reduced when patients had haemoglobin levels of 10 g/dL or less. If haemoglobin levels fell to below 8.5 g/dL, patients were given EPO. As mentioned in our report, only 16% of our patients had IL28b testing; the results of this test were not used to reach a decision on initiation of therapy. We did not collect hepatitis C virus genotype-1 subtype data, but future studies will certainly examine the effect that genotype and subtype may have on the occurrence of adverse events.