L-Carnitine Supplementation During Hepatitis C Virus Treatment with Sofosbuvir/Daclatasvir Plus Ribavirin: Effect on Anemia: A Pilot Study

Abstract
Background: In the direct acting antiviral era, the role of ribavirin (RBV) in the treatment of hepatitis c virus (HCV) remains crucial, especially in patients with liver cirrhosis and treatment experienced patients. L-carnitine was reported to improve anemia in patients with HCV treated with interferon alone or with ribavirin.
Aim of Study: To evaluate the effect of L-carnitine on improving ribavirin induced hemolytic anemia in patients with HCV treated with sofosbuvir/daclatasvir plus ribavirin (SOF/DCV/ RBV).
Patients and Methods: Naive patients with HCV related liver cirrhosis and treatment experienced patients who received prior interferon therapy were randomized to receive either SOF/DCV/RBV plus L-carnitine (n=49) or SOF/DCV/RBV (n=49) for 12 weeks as a control group. Changes in hemoglobin concentration, reduction of ribavirin dose and its effect on sustained virological response (SVR) were evaluated.
Results: After 4 and 12 weeks of treatment, the hemoglobin concentration was significantly higher in the L-carnitine group than in the control group (p<0.001). RBV dose was reduced in 10.2% of patients in the L-carnitine group versus 22.5% in the control group. The adherence of patients to their ribavirin dose was higher in patients treated with L-carnitine than patients in the control group (89.8% vs. 77.5%). SVR12 rate in the L-carnitine group was higher than that in the control group (93.9%% vs. 87.8%).
Conclusion: L-carnitine is effective in improving hemo-lytic anemia induced by ribavirin in patients treated for hepatitis C virus and increase patient's adherence to treatment that guarantees the best opportunity to achieve an SVR.