Interferon‐associated retinopathy in a uniform regimen of natural interferon‐α therapy for chronic hepatitis C

Saito, Hidetsugu; Ebinuma, Hirotoshi; Nagata, Hiroshi; Inagaki, Yasutaka; Saito, Yoshimasa; Wakabayashi, Kanji; Takagi, Toshikazu; Nakamura, Mitsuyasu; Katsura, Hiroshi; Oguchi, Yoshihisa; Ishii, Hiromasa

doi:10.1034/j.1600-0676.2001.021003192.x

Cited by 40 publications

(39 citation statements)

References 24 publications

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“…Several types of adverse reactions have been reported in patients undergoing antiviral therapy for chronic hepatitis C (35). In recipients of combination therapy, consisting of either standard IFN or PEG-IFN with RBV, hemolytic anemia (hemoglobin concentration of Ͻ100 g/liter) occurred frequently and led to dosage reduction or discontinuation of RBV treatment in 1% to 15% of patients (21,43).…”

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Role of Erythrocytes as a Reservoir for Ribavirin and Relationship with Adverse Reactions in the Early Phase of Interferon Combination Therapy for Chronic Hepatitis C Virus Infections

et al. 2006

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We investigated the relationship between serum ribavirin concentrations and clearance, as well as therapeutic efficacy and adverse reactions, in 97 Japanese patients with chronic hepatitis C virus infections treated with a 6-month course of high-dose alpha2b interferon (6 million units/day) plus ribavirin (600 to 800 mg/day) combination therapy. This randomized trial showed that the saturation of ribavirin uptake after taking ribavirin capsules does not occur within a dose range of 600 to 800 mg/day, which is a standard dosage used clinically in Japan. Serum ribavirin concentrations and clearance did not correlate with sustained virological response rates. Fourteen patients discontinued therapy because of adverse reactions, and sustained virological response rates were significantly reduced by discontinuation of therapy, while dose reduction of ribavirin did not alter the therapeutic effects. Ribavirin concentrations after 1 week and ribavirin clearance were significantly correlated with discontinuation of ribavirin; however, a multiple-regression analysis revealed that only hemoglobin concentration, but not ribavirin clearance, was a significant factor for discontinuation of therapy (odds ratio, 0.514; 95% confidence interval, 0.311 to 0.85; P ‫؍‬ 0.0095). It appears that peripheral erythrocytes may act as a reservoir for ribavirin and regulate serum ribavirin levels in the very early phase of treatment.It is estimated that 170 million people are infected with hepatitis C virus (HCV) worldwide, and the prevalence is 1% to 2% in developed countries (12,17). The natural history of hepatitis C involves the gradual progression to liver cirrhosis, with hepatocellular carcinoma as a final complication (44). The goal of therapy is to halt or decrease the progression of liver fibrosis (38), and interferon (IFN) therapy has been used for this purpose for more than a decade (33, 34). However, IFN-␣ and -␤ monotherapy is effective in a limited number of patients, with only 10% to 30% of patients experiencing a sustained virological response (SVR) to monotherapy (1,10,36,37). Many investigators, including our group, have tried alternative approaches to enhance SVR rates (5, 9), and based on these investigations, oral ribavirin (RBV) combination therapy is now a first-line treatment (2, 42). Recently, the pegylated form of IFN (PEG-IFN) was demonstrated to be significantly more effective in achieving SVRs than IFN combination therapy (23), and as a result, PEG-IFN and RBV combination therapy has been recently recommended as a standard therapy for HCV infection.Several types of adverse reactions have been reported in patients undergoing antiviral therapy for chronic hepatitis C (35). In recipients of combination therapy, consisting of either standard IFN or PEG-IFN with RBV, hemolytic anemia (hemoglobin concentration of Ͻ100 g/liter) occurred frequently and led to dosage reduction or discontinuation of RBV treatment in 1% to 15% of patients (21,43). Most patients treated with IFN plus RBV combination therapy experience a dec...

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Role of Erythrocytes as a Reservoir for Ribavirin and Relationship with Adverse Reactions in the Early Phase of Interferon Combination Therapy for Chronic Hepatitis C Virus Infections

et al. 2006

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“…1,3,7,[9][10][11][12][13][14] According to these reports, IFN-associated retinopathy did not cause visual loss in most cases.Although severe visual loss with IFN retinopathy can be caused by retinal capillary nonperfusion, central retinal vein occlusion, or anterior ischemic optic neuropathy, 1,5 temporary visual loss caused by macular edema has been rare.…”

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Clinical Course of Macular Edema in Two Cases of Interferon-Associated Retinopathy Observed by Optical Coherence Tomography

et al. 2005

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“…Chronic hypertension predisposes patients to IFN-induced retinopathy through thickening of the walls of the arteries and small arterioles (31). The fact that hypertensive retinopathy induces the formation of flame-shaped hemorrhages and white cotton-wool spots, which are also seen in IFN-induced retinopathy, implies that systemic hypertension and IFN-induced retinopathy may be related to each other (32).…”

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Ophthalmological side effects of interferon therapy of chronic hepatitis C

Medhat¹,

Esmat²,

Hamza³

et al. 2016

Hepatobiliary Surg. Nutr.

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Background: Egypt has one of the highest prevalence of hepatitis C virus (HCV) worldwide.Ophthalmological side effects are recognized complications of interferon (IFN) therapy. This study aimed to evaluate IFN-induced ophthalmological manifestations in patients receiving PEGylated interferon (PEG IFN) and ribavirin (RBV) and to assess the effect of IFN duration, response and systemic risk factors on the severity. Methods:We retrospectively analyzed 100 patients with chronic HCV who were candidates for PEG-IFN and RBV therapy. All patients were subjected to clinical and ophthalmological examination, laboratory investigations, abdominal ultrasound, colored fundus photography and fundus fluorescein angiography, follow up was made at weeks 12, 24, and 48 of treatment.Results: IFN-induced retinopathy had been found in (9/100; 9%), 5 (5/9; 55.5%) of them had bilateral lesions, (3/9; 33.3%) were treatment responders and (6/9; 66.6%) non responders. The time of retinopathy appearance was mainly at W12. Retinopathy was asymptomatic in most of the affected patients (7/9; 77.77%) and reversible, cotton wool spots was the major associated sign. Patients with older age, DM and or HTN, and non-responders to antiviral therapy were associated with more severe retinopathy. Conclusions:Retinopathy is not a rare complication of IFN therapy for chronic HCV infection, but fortunately it's asymptomatic and reversible. Ophthalmological assessment at base-line and at follow up during IFN treatment is very important.

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Interferon‐associated retinopathy in a uniform regimen of natural interferon‐α therapy for chronic hepatitis C

Abstract: Although it is not clear if interferon-associated retinopathy occurs in a dose-dependent manner, the present study shows a standard pattern of the occurrence of retinopathy in patients with chronic hepatitis C receiving a uniform dosage of natural interferon-alpha.

Cited by 40 publications

References 24 publications

Role of Erythrocytes as a Reservoir for Ribavirin and Relationship with Adverse Reactions in the Early Phase of Interferon Combination Therapy for Chronic Hepatitis C Virus Infections

Role of Erythrocytes as a Reservoir for Ribavirin and Relationship with Adverse Reactions in the Early Phase of Interferon Combination Therapy for Chronic Hepatitis C Virus Infections

Clinical Course of Macular Edema in Two Cases of Interferon-Associated Retinopathy Observed by Optical Coherence Tomography

Ophthalmological side effects of interferon therapy of chronic hepatitis C

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