Long‐term treatment with interferon‐α2b for severe pruritus in patients with polycythaemia vera

Abstract

Pruritus is a major clinical problem in patients with polycythaemia vera (PV). Conventional symptomatic treatment is unsatisfactory. Recently, a favourable effect of interferon-alpha on pruritus in patients with PV has been reported. Also, interferon-alpha suppresses the increased haemopoiesis in PV. However, long-term treatment with interferon-alpha may be hampered by side-effects and the inconvenience of chronic subcutaneous injection therapy. We conducted a long-term study (median follow-up 13 months) of the efficacy and tolerability of interferon-alpha in 15 patients (mean age 68 years) with PV and severe pruritus. Six patients were evaluable after 1 year. Pruritus significantly improved in 12/15 patients. Haematological control improved, as evidenced by a decreased number of phlebotomies from a mean of 4.3 in the year before the study to 1.8 while on interferon-alpha. Leucocyte and platelet numbers also decreased significantly. Five patients (33%) did not tolerate interferon-alpha. The effects of interferon-alpha could not be ascribed to an inhibitive effect on histamine production or to the disappearance of the abnormal erythroid progenitor clone, because erythropoietin-independent erythroid colony formation persisted during interferon-alpha treatment. We conclude that long-term interferon-alpha treatment is feasible and effectively relieves pruritus in patients with PV, but side-effects are an important concern. The optimal dose regimen that is well tolerated, relieves pruritus, and offers satisfactory haematological control at the same time remains to be established.

Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis, risk‐stratification and management

“…In contrast, recent studies have suggested a greater than 50% response rate in PVassociated pruritus treated with paroxetine (20 mg/day), which is a selective serotonin reuptake inhibitor [84]. Other treatment modalities that have been reported to be useful in PV-associated pruritus include JAK inhibitors [85], interferon-a (IFN-a) [86] and narrow-band ultraviolet B phototherapy [87] Recommendations in the management of low-risk ET or PV without extreme thrombocytosis…”

Polycythemia vera‐associated pruritus and its management

“…Twelve of 15 patients with severe PV-associated pruritus showed significant improvement with IFN-a therapy [41]. Eight of 13 (61AE5%) patients with intractable itching reported a ‡ 50% reduction of pruritus 2-8 weeks after starting IFN-a [11].…”

Pruritus in primary myelofibrosis: management options in the era of JAK inhibitors

“…Studies of selective serotonin NA Not available reuptake inhibitors, specifically paroxetine, have shown greater than 50 % response rates in PV-associated pruritus [3,14,20]. Other treatment modalities that have been reported to be useful in PV-associated pruritus include JAK inhibitors [3,9,11,14], IFN-α [32], and narrowband ultraviolet B phototherapy [21], while response to both hydroxyzine and antihistamines in PV-associated pruritus has been more variable [3,9]. There is less published data regarding treatment options and their effectiveness for patients with PMF and pruritus.…”