Polyethylene Glycol Interferon .ALPHA.-2b-induced Immune-mediated Polyradiculoneuropathy

Abstract

Polyethylene glycol-interferon α (PEG-IFNα) has been used as the standard treatment for hepatitis C virus (HCV) infection. There have been no previous reports of polyradiculoneuropathy with anti-ganglioside antibodies induced by PEG-IFNα-2b. We report a 59-year-old man who developed polyradiculoneuropathy during treatment with PEG-IFN α-2b for chronic HCV infection. Serum levels of anti-asialo-GM1 (GA1) and anti-GM1 antibodies were elevated. Cessation of therapy with double filtration plasmapheresis resulted in marked improvement in his symptoms accompanied by a reduction in the antibody level. PEG-IFN α-2b may induce peripheral neuropathy mediated by anti-GA1 and anti-GM1 antibodies.

Chronic Inflammatory Demyelinating Polyneuropathy Due to the Administration of Pegylated Interferon .ALPHA.-2b: A Neuropathology Case Report

“…Nevertheless, seven distinct cases of CIDP have been reported after the administration of a variety of IFNα species, including IFNα (6-9), pegIFN α-2a (10), and pegIFN α-2b (11,12). The interval between the administration of IFNα and the onset of CIDP ranged from 3 weeks to 11 months.…”

“…On the other hand, however, a favorable outcome was reported in all of the reported cases of IFNα-induced CIDP when the patients were treated with any of the standard therapies for CIDP, including oral steroids (6,8), plasma exchange (7,11), or IVIG (8)(9)(10)12). In the present case, three courses of IVIG were administered, but no maintenance immunomodulatory therapy was needed.…”

“…On the other hand, autoimmunity is a well-recognized complication of IFNα therapy, with reported frequencies ranging between 4.3% and 18.5% in large observational studies (3)(4)(5). Neuropathies due to administration of IFNα are a rare complication (3,4); however, eight distinct case reports have shown that chronic inflammatory demyelinating polyneuropathy (CIDP) can result from administration of IFNα, presumably due to perturbations in the host immune system (6)(7)(8)(9)(10)(11)(12)(13). We here report a biopsy-proven case with IFNα-induced CIDP in which the serum value of tumor necrosis factor-α (TNFα) was elevated.…”

Drug-induced dysimmune demyelinating neuropathies

“…Electrodiagnostic studies were compatible with a demyelinating process; some nerves showed multifocal conduction blocks [51,53,54,57]. Serum of 1 patient with CIDP showed presence of cryoglobulins and elevated anti-GA1/anti-GM1 antibody titers [56]. Nerve biopsies showed primary demyelination with [56] or without axonal degeneration, and without vasculitis [53,55,56].…”

“…Serum of 1 patient with CIDP showed presence of cryoglobulins and elevated anti-GA1/anti-GM1 antibody titers [56]. Nerve biopsies showed primary demyelination with [56] or without axonal degeneration, and without vasculitis [53,55,56]. IFNα therapy was discontinued in all patients, but CIDP progressed for weeks thereafter [50,51,57].…”