Interferon-α2a and Vogt–Koyanagi–Harada disease: a double-edged sword?

Abstract

Successful therapy based on the use of interferon-alpha has been reported in different types of severe chronic uveitis. The immunomodulatory effects of this drug, combined with its antiviral properties seem to contribute to its efficacy in the treatment of different forms of severe and refractory uveitis such as Vogt-Koyanagi-Harada disease, Behçet-associated uveitis, or even human herpes virus 8 (HHV-8) associated uveitis. At the same time, severe ocular complications have been reported in patients treated with interferon-alpha for chronic viral hepatitis C. Among these complications, six cases of Vogt-Koyanagi-Harada-like disease have been described.We report a small case series of two patients with refractory Vogt-Koyanagi-Harada disease, treated with interferon-alpha and discuss the potential benefits or detrimental role of interferon therapy in these patients.

Reappraisal of the management of Vogt–Koyanagi–Harada disease: sunset glow fundus is no more a fatality

“…An immunosuppressant increasingly chosen by clinicians is mycophenolate mofetil (CellCept ® , 1000 mg twice daily) or mycophenolic acid (Myfortic ® , 720 mg twice daily) because this agent is both very effective and usually well tolerated. Other immunosuppressing drugs or biologic agents that have been reported are cyclosporine, anti-TNF agents or interferon-alpha, noting for the latter that it can itself induce VKH disease [ 55 , 56 ].…”

Anti-inflammatory treatment of uveitis with biologicals: new treatment options that reflect pathogenetic knowledge of the disease

“…The additional use of corticosteroids at initiation or during continued IFN-α2a treatment is controversial, but has been shown to be effective [191]. The use of IFN-α2a has been extended to the treatment of occlusive vasculitis, pediatric Behçet's patients, Vogt-Koyanagi-Harada's disease, and cystoid macular edema [192][193][194].…”

Vogt–Koyanagi–Harada disease occurring during interferon-alpha and ribavirin therapy for chronic hepatitis C virus infection

“…Interferonalpha and ribavirin therapy seems to exacerbate preexisting autoimmune conditions, such as rheumatoid arthritis and psoriasis, and can trigger the de novo development of various autoimmune diseases, such as thyroiditis, hepatitis, diabetes, Mooren's ulcer, sarcoidosis, systemic lupus erythematous, haemolytic anaemia, immune-mediated thrombocytopaenia and vitiligo [9,10]. Interferon-related VKH disease and other autoimmune diseases in patients with hepatitis C virus infection can be due to the immunomodulatory effect of interferon therapy, including enhanced lymphocyte cytotoxicity, increased expression of major histocompatibility class I antigens, production of proinflammatory cytokines and differentiation of antigen-presenting cells which might make individuals susceptible for autoimmune diseases in the presence of triggering factors such as hepatitis C virus infection [4].…”