Skin Reaction in Antiviral Therapy for Chronic Hepatitis C: A Role for Polyethylene Glycol Interferon?

Abstract

In the past decade, different modalities of antiviral therapy have been adopted aimed at eradicating hepatitis C virus infection. Initially, interferon was used in monotherapy, then interferon combined with ribavirin and amantadine. Recently, interferon has been conjugated with polyethylene glycol to allow optimization of its pharmacokinetic properties and to improve its antiviral activity. This study focused on the characteristics of the skin reactions that we observed in 27 patients with naïve hepatitis C who received polyethylene glycol interferon-ribavirin-amantadine or polyethylene glycol interferon-ribavirin and in 10 previous non-responders to interferon monotherapy who were retreated with triple therapy. In 9 patients (7 on triple therapy) dermatitis-like lesions were observed, and in 5 the severity of the lesions necessitated withdrawal from therapy.

Severe Allergic Eczema due to Pegylated α-Interferon may Abate After Switching to Daily Conventional α-Interferon

“…Severe skin reactions not responding to treatment with topical steroids and antihistamines, may lead to treatment discontinuation. 7 This markedly reduces the chance of sustained virologic response. In such cases, switching to daily conventional a-interferon may still allow affected patients to continue their antiviral treatment and reach a sustained virologic response.…”

Adverse Skin Reactions due to Ribavirin in Hepatitis C Combination Therapy with Pegylated Interferon-α2a

“…There has been 1 prospective study on the de novo onset of skin symptoms associated with PEG-IFN-α 2a and ribavirin combination treatment [1], and there have been some reports of drug eruption caused by ribavirin and PEG-IFN-α 2b [2, 3] or IFN-α combination therapy [4, 5]. Most cases were not severe and improved only with a topical steroid and oral anti-allergic drug, without the need for discontinuation of the antiviral treatment.…”

“…Most cases were not severe and improved only with a topical steroid and oral anti-allergic drug, without the need for discontinuation of the antiviral treatment. Severe cases required a discontinuation of the antiviral treatment [3, 4, 5]; a steroid was administered in very severe cases [2, 3]. …”

Allergic sensitization to pegylated interferon‐α results in drug eruptions

“…Pegylation refers to the modification of proteins by adding polyethylene glycol (PEG), leading to enhanced delivery, prolonged pharmacologic activity, and potentially reduced immunogenicity and antigenicity . Despite the advantages of PEG‐IFN, cessation of therapy is often reported due to significant adverse drug reactions (ADRs) occurring in up to 48% of the treated patients .…”

“…Adverse drug reaction can be divided into two categories based on underlying pathomechanisms: type A reactions, defined by unanticipated pharmacologic actions, and, type B reactions characterized by intolerance, idiosyncratic, and allergic or hypersensitivity reactions . The underlying pathomechanisms of ADRs caused by PEG‐IFNs have remained largely elusive . The frequently observed localized inflammatory skin lesions at the site of PEG‐IFN injection may reflect the pro‐inflammatory properties of IFN‐α.…”