Severe exacerbation of hepatitis C–associated vasculitic neuropathy following treatment with interferon alpha: A case report and literature review

Boonyapisit, Kanokwan; Katirji, Bashar

doi:10.1002/mus.10118

Cited by 90 publications

(40 citation statements)

References 22 publications

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“…Among the infrequently reported (Ͻ1%) prominent serious adverse events associated with standard interferon therapy are retinopathy, retinal hemorrhage, visual loss, tinnitus, hearing loss, cardiac arrhythmias, congestive heart failure, interstitial pneumonitis, acute renal failure, bacterial infections (particularly in patients with cirrhosis), and induction or exacerbation of autoimmune diseases, hyperthyroidism, hypothyroidism, acute psychosis, panic attacks, severe depression, and suicide. 2,[10][11][12][13][14][15][16][17][18][19] Healthcare providers should be aware that some of these isolated events have also been reported rarely in association with peginterferon therapy (see package inserts), so that appropriate aggressive investigations may be undertaken when warranted.…”

Section: Uncommon Serious Adverse Eventsmentioning

confidence: 99%

Side effects of therapy of hepatitis C and their management

2002

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Interferon and ribavirin combination therapy for chronic hepatitis C produces a number of well-described side effects that are dominated by fatigue, influenza-like symptoms, hematologic abnormalities, and neuropsychiatric symptoms. Combination therapy with pegylated interferons (peginterferon alfa-2a and alfa-2b) yields an adverse event profile similar to standard interferon, although the frequency of certain adverse events may vary by preparation. Premature withdrawal from therapy due to adverse events was required in 10% to 14% of participants in registration trials of these agents. Most adverse events were safely and effectively managed by dose reduction using predetermined criteria. The most common indications for dose reduction were hematologic abnormalities, such as anemia and neutropenia, with the latter more frequent in peginterferon treatment arms. Recent data suggest that maintaining adherence to a prescribed treatment regimen can enhance antiviral response. Strategies to maximize adherence are being developed and, in the future, may include early identification of and therapy for depression and the selective use of hematopoietic growth factors to ameliorate hematologic abnormalities. (HEPATOLOGY 2002;36: S237-S244.)T he side effect profile of combination therapy using standard interferon and ribavirin has been well described. [1][2][3][4] The major types of side effects include fatigue, influenza-like symptoms, gastrointestinal disturbances, neuropsychiatric symptoms, and hematologic abnormalities. 1,2 These side effects may be treatment limiting and require dose reduction or drug discontinuation. 3,4 Numerous other side effects occur with lower frequencies but may still have an impact on the tolerability of antiviral therapy. 2 Pegylated interferons (peginterferon alfa-2a and peginterferon alfa-2b) have significantly improved pharmacokinetics, 5-8 resulting in improved antiviral efficacy, which also has the potential to alter the side effect profile. This review will focus on the frequency and management of side effects reported with the use of peginterferon and ribavirin for the treatment of chronic hepatitis C based on data from 2 large registration trials that compared these agents with standard interferon and ribavirin combination therapy. Peginterferon Alfa-2a and RibavirinDiscontinuations and Dose Modification. The results of a large phase III clinical trial of peginterferon alfa-2a and ribavirin have been reported recently. 8 More than 1,100 subjects were randomized to therapy with peginterferon alfa-2a and ribavirin, peginterferon alfa-2a and placebo, or standard interferon alfa-2b and ribavirin. Premature withdrawal from therapy due to laboratory abnormalities or adverse events in the combination arms with either peginterferon (10%) or standard interferon (11%) was comparable 8 (Table 1). Interestingly, this rate of discontinuation for either combination arm was lower than previously reported in earlier trials using standard interferon and ribavirin (approximately 20%), 4,9 suggesting improv...

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Section: Uncommon Serious Adverse Eventsmentioning

confidence: 99%

Side effects of therapy of hepatitis C and their management

2002

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“…In addition, deterioration of vasculitis in patients with cryoglobulins without any new onset of vasculitis has been described (47). This observation has been confirmed by other studies (48). As a result, it is important for clinicians to be aware of these potentially severe side effects.…”

Section: Phatophysiology Of Hcv-related Cryoglobulinemiamentioning

confidence: 65%

Hepatitis C Virus Cryoglobulinemia and Non-Hodgkin Lymphoma

Jadali

2012

Hepat Mon

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Context: On the strength of epidemiological data,biological studies, and clinical findings, hepatitis C virus appears to be involved in the pathogenesis of a proportion of patients with non-Hodgkin lymphoma and cryoglobulinemia. Objectives: The aim of this paper is to review the published literature focused on the current knowledge concerning hepatitis C virus and its potential role in the production of non-Hodgkin lymphoma and cryoglobulinemia in susceptible individuals. Evidence Acquisition: In this review, databases such as pubMed, embase, ISI, and Iranian databases including Iranmedex, and SID were searched. Results: The results of this review indicate that HCV infection may be a likely cause of various B cell dysregulation disorders such as non-Hodgkin lymphoma and cryoglobulinemia.Conclusion: Based on current findings, it has been hypothesized that NHL and cryoglobulinemia in HCV infection may have an immune-mediated pathogenesis. In HCV infected patients, we showed an elevated risk of these two diseases. These finding suggested a possible role for chronic hepatitis C in the pathogenesis of NHL and cryoglobulinemia.

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“…Treatment with non-pegylated type IFN has been reported to be complicated by various types of peripheral neuropathy, including demyelinating polyneuropathy, axonal neuropathy, and vasculitic neuropathy (2)(3)(4) (9), multiple motor neuropathy (MMN) (10), CIDP (11), and ataxic neuropathy (12). However its pathological implications are not well understood.…”

Section: There Are Millions Of Patients Worldwide With Chronic Hepatimentioning

confidence: 99%

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

et al. 2009

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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.

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Severe exacerbation of hepatitis C–associated vasculitic neuropathy following treatment with interferon alpha: A case report and literature review

Cited by 90 publications

References 22 publications

Side effects of therapy of hepatitis C and their management

Side effects of therapy of hepatitis C and their management

Hepatitis C Virus Cryoglobulinemia and Non-Hodgkin Lymphoma

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

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