|
1
|
Arena R, Cecinato P, Lisotti A, Buonfiglioli F, Calvanese C, Grande G, Montagnani M, Azzaroli F, Mazzella G. Severe immune thrombocytopenia after peg-interferon-alpha2a, ribavirin and telaprevir treatment completion: A case report and systematic review of literature. World J Hepatol 2015; 7:1718-1722. [PMID: 26140092 PMCID: PMC4483554 DOI: 10.4254/wjh.v7.i12.1718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/01/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
Mild to moderate autoimmune thrombocytopenia (AITP) is a common finding in patients receiving interferon-based antiviral treatment, due to bone marrow suppression. Here we report the case of a patient with chronic genotype 1b hepatitis C virus (HCV) infection treated with pegylated-interferon alpha-2a, ribavirin and telaprevir for 24 wk; the patient developed severe AITP three weeks after treatment withdrawal. We performed a systematic literature search in order to review all published cases of AITP related to HCV antiviral treatment. To our knowledge, this is the second case of AITP observed after antiviral treatment withdrawal. In most published cases AITP occurred during treatment; in fact, among 24 cases of AITP related to interferon-based antiviral treatment, only one occurred after discontinuation. Early diagnosis of AITP is a key factor in order to achieve an early interferon discontinuation; in the era of new direct antiviral agents those patients have to be considered for interferon-free treatment regimens. Prompt prescription of immuno-suppressant treatment (i.e., corticosteroids, immunoglobulin infusion and even rituximab for unresponsive cases) leads to favourable prognosis in most of cases. Physicians using interferon-based treatments should be aware that AITP can occur both during and after treatment, specially in the new era of interferon-free antiviral treatment. Finally, in the case of suspected AITP, presence of anti-platelet antibodies should be checked not only during treatment but also after discontinuation.
Collapse
Affiliation(s)
- Rosario Arena
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Paolo Cecinato
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Andrea Lisotti
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Federica Buonfiglioli
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Claudio Calvanese
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Giuseppe Grande
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Marco Montagnani
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Francesco Azzaroli
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Giuseppe Mazzella
- Rosario Arena, Paolo Cecinato, Andrea Lisotti, Federica Buonfiglioli, Claudio Calvanese, Giuseppe Grande, Marco Montagnani, Francesco Azzaroli, Giuseppe Mazzella, Department of Medical and Surgical Science - DIMEC, University of Bologna, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy
| |
Collapse
|
|
3
|
A review of adverse cutaneous drug reactions resulting from the use of interferon and ribavirin. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:677-83. [PMID: 19826642 DOI: 10.1155/2009/651952] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Drug-induced cutaneous eruptions are named among the most common side effects of many medications. Thus, cutaneous drug eruptions are a common cause of morbidity and mortality, especially in hospital settings. The present article reviews different presentations of drug-induced cutaneous eruptions, with a focus on eruptions reported secondary to the use of interferon and ribavirin. Presentations include injection site reactions, psoriasis, eczematous drug reactions, alopecia, sarcoidosis, lupus, fixed drug eruptions, pigmentary changes and lichenoid eruptions. Also reviewed are findings regarding life-threatening systemic drug reactions.
Collapse
|
|
4
|
de Almeida AJ, Campos-de-Magalhães M, Antonietti CL, Brandão-Mello CE, da Silva MLP, de Oliveira RV, do Espírito-Santo MP, Yoshida CFT, Lampe E. Autoimmune thrombocytopenia related to chronic hepatitis C virus infection. ACTA ACUST UNITED AC 2009; 14:49-58. [PMID: 19154665 DOI: 10.1179/102453309x385106] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Since the identification of hepatitis C virus (HCV) in 1989 as a causative agent for a number of the extrahepatic alterations related to HCV infection an underlying immune mediated pathogenetic mechanism has been postulated. HCV-associated thrombocytopenia may be considered complex and multifactorial in origin, since different mechanisms have been implicated in its pathophysiology. With respect to autoimmune thrombocytopenia in chronic HCV infection, the detection of specific antibodies against platelet glycoproteins have been reported only in a few studies, but no systematic study has been carried out. We examined the clinical, laboratory, and virological characteristics of a case series of 10 patients with autoimmune thrombocytopenia (platelet count <150.0 x 10(9)/L) related to chronic HCV infection. Cases, six males and four females, aged 57.1 +/- 12.6 years, presented high titers of antibodies against platelet glycoprotein (GP) IIb/IIIa, GP Ia/IIa, and/or GP Ib/IX, and no other mechanism involved in the pathogenesis of HCV-associated thrombocytopenia was identified. Furthermore, cases were not associated with particular HCV genotype. Complete platelet response was observed in two patients treated with pegylated interferon plus ribavirin, and partial platelet response was seen in two patients treated with anti-D Ig and one patient treated with corticosteroids. These findings indicate that an autoimmune mechanism may play a role in the pathogenesis of HCV-associated thrombocytopenia in a proportion of these patients.
Collapse
Affiliation(s)
- A J de Almeida
- Viral Hepatitis Laboratory, Pav. Hélio & Peggy Pereira, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
5
|
Li L, Lv J, Xiao M, Luo XL, Zheng JF, Han DK. Clinical features of 27 cases with interferon alpha- induced severe thrombocytopenia. Shijie Huaren Xiaohua Zazhi 2009; 17:1147-1151. [DOI: 10.11569/wcjd.v17.i11.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze clinical features of interferon alpha-induced severe thrombocytopenia.
METHODS: Twenty six cases with interferon alpha-induced severe thrombocytopenic purpu-ra were collected from Medline and CNKI and another case from our clinical practice, and all cases were classified into two groups: immune thrombocytopenic purpura group and throm-botic thrombocytopenic purpura group accord-ing to their mechanism. Clinical manifestations, results of laboratory examinations, treatment and prognosis of different groups were observed and analyzed.
RESULTS: Twenty four cases of ITP presented hemorrhagic tendency, severe thrombocytope-nia, elevated antiplatelet antibody or platelet related IgG, megacaryocyte hyperplasia. The platelet counts increased after discontinuation of IFNα and treatment with immune suppression agents for 1 or 2 weeks and the prognosis of ITP was good. Three cases of TTP presented fever, decreased platelet count, hemolytic anemia, neu-ropsychological symptoms and renal disorder. Plasma transfusion was the main therapy with poor prognosis and high mortality. ITP and TTP usually occurred in the process of anti- HCV treatment of IFNα.
CONCLUSION: Two kinds of IFNα-induced se-vere thrombocytopenia could occur during the process of anti-virus. Physicians should recog-nize and treat them in time correctly.
Collapse
|
|
6
|
Mironova R, Sredovska A, Ivanov I, Niwa T. Maillard reaction products in the Escherichia coli-derived therapeutic protein interferon alfacon-1. Ann N Y Acad Sci 2007; 1126:181-4. [PMID: 18079487 DOI: 10.1196/annals.1433.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We have recently shown that recombinant human interferon-gamma is affected by early stages of the Maillard reaction during its production in Escherichia coli. Over time, advanced glycation end products accumulated in the purified protein, accompanied with degradation, cross-linking, and a drop in the protein's biologic activity. Here, we provide further evidence for the presence of Maillard reaction products in another E. coli-derived therapeutic protein, interferon alfacon-1. These products might interfere with both treatment efficacy and patient safety.
Collapse
Affiliation(s)
- Roumyana Mironova
- Department of Gene Regulations, Institute of Molecular Biology, Bulgarian Academy of Sciences, Sofia, Bulgaria.
| | | | | | | |
Collapse
|