Development of ulcerative colitis in a patient with multiple sclerosis following treatment with interferonβ 1a

Abstract

To alert clinicians to a potential novel adverse drug effect of interferonb 1a, we herein report a patient with relapsing-remitting multiple sclerosis who developed ulcerative colitis following treatment with interferonb 1a. Ulcerative colitis persisted despite discontinuation o f i n t e r f e r o n b 1 a t r e a t m e n t a n d s w i t c h i n g t h e patient to glatiramer acetate. Tacrolimus (FK506), 6-mercaptopurine, and prednisolone were required to induce remission. Both ulcerative colitis and multiple sclerosis were eventually well controlled using this regimen. Our report underscores that caution should be exercised when prescribing immunostimulatory agents in patients with inflammatory bowel disease (IBD) and challenges current efforts to stimulate innate immunity as a novel therapeutic concept for IBD.

Type I IFN induces protein ISGylation to enhance cytokine expression and augments colonic inflammation

“…Interestingly, recent studies also uncovered a proinflammatory role for type I IFNs in an experimental colitis model (9). In clinical practice, some patients who were treated with type I IFN for hepatitis C infection or multiple sclerosis either experienced an exacerbation of existing UC or developed UC (5,10). These studies in animal models and clinical observations indicate a complicated role for type I IFNs during intestinal inflammation.…”

Multiple sclerosis and inflammatory bowel disease: what implications in therapeutic decisions?

“…It also induces GA-specific CD4+ and CD8+ T cells that inhibit the inflammatory process in the brain [26]. Finally, in a mouse model of experimental colitis, GA relieved colitis symptoms and inhibited the production of TNF-alpha, an important mediator of inflammation in both MS and IBD [27]. These actions, altogether, were believed to be beneficial in our patient with evidence of progression of disease.…”

Development of Crohn’s Disease in a Patient with Multiple Sclerosis Treated with Copaxone

“…Copaxone also led to amelioration of T-cell proliferation in in vitro studies [3, 6]. Anti-MS drugs (interferon-β 1a and Copaxone) with anti-inflammatory and anti-immune characteristics were shown to be effective in IBD treatment [7,8,9]. Interferon-β 1a was shown to be effective in steroid-refractory active ulcerative colitis [9].…”

“…Anti-MS drugs (interferon-β 1a and Copaxone) with anti-inflammatory and anti-immune characteristics were shown to be effective in IBD treatment [7,8,9]. Interferon-β 1a was shown to be effective in steroid-refractory active ulcerative colitis [9]. Several reports, however, have recently appeared in the literature showing ‘paradoxical’ findings in terms of the development or aggravation of ulcerative colitis after treatment with interferons [9].…”

“…Interferon-β 1a was shown to be effective in steroid-refractory active ulcerative colitis [9]. Several reports, however, have recently appeared in the literature showing ‘paradoxical’ findings in terms of the development or aggravation of ulcerative colitis after treatment with interferons [9]. …”