Autoimmune Thrombocytopenic Purpura during Pegylated Interferon .ALPHA. Treatment for Chronic Hepatitis C

Kim, Soo Ryang; Imoto, Susumu; Kudo, Masatoshi; Nakajima, Takahiro; Ando, Kenji; Mita, Keiji; Fukuda, Katsumi; Hong, Hyun Soo; Lee, Yeong Ho; Nakashima, Keiichi; Shoji, Ikuo; Nagano-Fujii, Motoko; Hotta, Hak; Hayashi, Yoshitake

doi:10.2169/internalmedicine.49.3413

Cited by 5 publications

(2 citation statements)

References 11 publications

(6 reference statements)

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“…Treatment of patients with all forms of IFN-a, with or without cotreatment with the antiviral ribavirin, is associated with mild (grades 2-3) or severe (grade 4) thrombocytopenia (Elefsiniotis et al 2006;Kim et al 2010;Li, Han, and Lu 2010;Sagir et al 2002;Sevastianos et al 2003;Yang et al 2010). Thrombocytopenia associated with IFN-a therapy occurs most frequently in hepatitis C patients (Dourakis, Deutsch, and Hadziyannis 1996;Fujii et al 2003;Kim et al 2010;Li, Han, and Lu 2010;Medeiros et al 2004;Sevastianos et al 2003) and is also reported in oncology patients (Abdi, Brien, and Venner 1986;Akamatsu et al 2006;Demirturk et al 2006;McLaughlin et al 1985;Zuffa et al 1996). Because diseases treated with IFN-a are also those that predispose patients to thrombocytopenia, the direct relationship of thrombocytopenia to IFN-a therapy can be difficult to elucidate (Ramos-Casals et al 2003) The mild form of IFN-a-related thrombocytopenia is most common and occurs in approximately 23% of patients (Alvarez et al 2011;Ernstoff and Kirkwood 1984).…”

Section: Interferon Alphamentioning

confidence: 99%

Unexpected Hematologic Effects of Biotherapeutics in Nonclinical Species and in Humans

Everds

Tarrant²

2013

Toxicol Pathol

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Biotherapeutics are expanding the arsenal of therapeutics available for treating and preventing disease. Although initially thought to have limited side effects due to the specificity of their binding, these drugs have now been shown to have potential for adverse drug reactions including effects on peripheral blood cell counts or function. Hematotoxicity caused by a biotherapeutic can be directly related to the activity of the biotherapeutic or can be indirect and due to autoimmunity, biological cascades, antidrug antibodies, or other immune system responses. Biotherapeutics can cause hematotoxicity primarily as a result of cellular activation, cytotoxicity, drug-dependent and independent immune responses, and sequelae from initiating cytokine and complement cascades. The underlying pathogenesis of biotherapeutic-induced hematotoxicity often is poorly understood. Nonclinical studies have generally predicted clinical hematotoxicity for recombinant cytokines and growth factors. However, most hematologic liabilities of biotherapeutics are not based on drug class but are species specific, immune-mediated, and of low incidence. Despite the potential for unexpected hematologic toxicity, the risk-benefit profile of most biotherapeutics is favorable; hematologic effects are readily monitorable and managed by dose modification, drug withdrawal, and/or therapeutic intervention. This article reviews examples of biotherapeutics that have unexpected hematotoxicity in nonclinical or clinical studies.

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Section: Interferon Alphamentioning

confidence: 99%

Unexpected Hematologic Effects of Biotherapeutics in Nonclinical Species and in Humans

Everds

Tarrant²

2013

Toxicol Pathol

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“… 2 , 3 Immune thrombocytopenic purpura (ITP) is rarely reported during the IFN treatment course. 5 – 11 , 15 , 21 – 24 Here, we reported a case who developed immune-mediated thrombocytopenia 2 weeks after withdrawal of IFN treatment.…”

Section: Introductionmentioning

confidence: 94%

Late-Onset Immune Thrombocytopenic Purpura After Withdrawal of Interferon Treatment for Chronic Hepatitis C Infection

Hsiao

Tseng

et al. 2015

Medicine

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Immune thrombocytopenic purpura (ITP) is a life-threatening complication following pegylated interferon alpha (PEG-IFN) plus ribavirin treatment, the standard treatment for hepatitis C virus (HCV) infection. We reported a rare case with late-onset ITP after withdrawal of PEG-IFN treatment.A 53-year-old male with hepatitis C developed massive gum bleeding and a severe, reversible, immune thrombocytopenia 2 weeks after cessation of PEG-IFN treatment for HCV due to anemia and depression. The platelet count decreased to 4000 cells/μL. The HCV viral load was undetectable at the end of PEG-IFN treatment and during follow-up for 5 months. Other potential autoimmune disorders were ruled out. Late-onset ITP associated with PEG-IFN treatment was diagnosed.The patient was treated successfully with steroid and azathioprine. Platelet count gradually increased to 117 × 103 cells/μL on the 18th day after admission.ITP is a rare complication in patients with hepatitis C or in patients who received PEG-IFN treatment. The particular case supported that it may occur even after withdrawal of PEG-IFN treatment. Physicians should be aware of this late-onset complication.

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Predisposing Factors of Hepatocellular Carcinoma Recurrence Following Complete Remission in Response to Transarterial Chemoembolization

et al. 2013

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Autoimmune Thrombocytopenic Purpura during Pegylated Interferon .ALPHA. Treatment for Chronic Hepatitis C

Abstract: We describe a 72-year-old woman with chronic hepatitis C and autoimmune thrombocytopenic purpura (AITP) during pegylated interferon (PEG-IFN)

Cited by 5 publications

References 11 publications

Unexpected Hematologic Effects of Biotherapeutics in Nonclinical Species and in Humans

Unexpected Hematologic Effects of Biotherapeutics in Nonclinical Species and in Humans

Late-Onset Immune Thrombocytopenic Purpura After Withdrawal of Interferon Treatment for Chronic Hepatitis C Infection

Predisposing Factors of Hepatocellular Carcinoma Recurrence Following Complete Remission in Response to Transarterial Chemoembolization

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