Interferon treatment for multiple sclerosis

Abstract

are constantly negative, and peripheral T CD4+ cells remain low (last determination, 173 cells/mm").Severe CNS HSV-1 infections have never been described in patients with idiopathic T CD4t lymphocytopenia, despite the relevant role played by cellular immunity against HSV-1. Interestingly, our patient presented a radiologic picture of diffuse leukoencephalomyelitis, which is a very unusual presentation of CNS HSV-1 infection, even in patients with AIDS.6 Although the detection of HSV by PCR in CSF without histopathologic confirmation is not always diagnostic of HSV-related disease of the CNS in immunocompromised patients: the favorable response with regression of the clinical and radiologic involvement under antiherpetic therapy seems highly supportive of this diagnosis. As usually observed in patients with T CD4+ idiopathic lymphocytopenia,"6 it is impossible to establish the level of circulating T CD4+ cells before the development of the case-index disease, which was HSV meningoencephalomyelitis in our patient. It is, however, of note that the number of circulating T CD4+ cells remained extremely low 1 year after the acute episode.We conclude that clinicians should be aware that CNS herpetic diseases (also with unusual radiologic presentation) can occur in patients with T CD4+ cell deficiency other than HIV induced. These infections, in our opinion, require a more aggressive therapy than in an immunocompetent host, whereas the effectiveness of a long-term prophylaxis remains open to study.

Hepatic injury, liver monitoring and the beta-interferons for multiple sclerosis

“…However, they are often indicated in situations, such as chronic viral hepatitis, where subsequent hepatotoxicity could be attributed to the underlying disease itself.There have been four reports in the literature of liver failure in MS patients also taking an interferon -IFN-alpha-2a which was never licensed in MS [35], IFNB-1a(sc) [36,37] and IFNB-1a(im) [38]. Thirty serious cases of symptomatic liver dysfunction were reported in a review article from one of the pharmaceutical manufacturers of IFNB [37].…”

Suspected autoimmune hepatitis and primary biliary cirrhosis unmasked by interferon-beta in a multiple sclerosis patient

“…The use of IFN-b in MS is associated with autoimmune hepatitis (Durelli et al, 1998;Pulicken et al, 2006;Grieco et al, 2007), hepatotoxicity (Tremlett et al, 2004) and fulminant liver failure (Yoshida et al, 2001) and can occur years into treatment (Grieco et al, 2007). The use of IFN-b for MS has not been associated with unmasking PBC or precipitating de novo antimitochondrial antibodies (the classic serologic marker of PBC).…”

Development of autoimmune hepatitis type 1 after pulsed methylprednisolone therapy for multiple sclerosis: A case report

“…In patients with MS receiving IFN-β, if de novo elevation of aminotransferases is mild, IFN-β treatment is often continued, and elevated aminotransferases return to almost nor mal [4] . However, severe liver dysfunction does not resolve simply after stopping IFN-β, and prompt treatment is needed.…”

“…IFN-β is associated with hepatotoxicity, although it rarely induces severe liver injury. It was reported that autoimmune hepatitis (AIH) occurs during IFN-β therapy for MS [3,4] , but only one report has described the occurrence of AIH after intravenous methylprednisolone pulse therapy for MS [5] . We describe herein a case of a MS patient who developed AIH after treatment with IFN-β and pulsed methylprednisolone.…”