Retinal vein thrombosis associated with chronic hepatitis C: a case series and review of the literature

Nadir, Abdul; Amin, Ali H.; Chalisa, Nuzhat; Thiel, David H. Van

doi:10.1046/j.1365-2893.2000.00245.x

Cited by 44 publications

(34 citation statements)

References 22 publications

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“…Among the infrequently reported (Ͻ1%) prominent serious adverse events associated with standard interferon therapy are retinopathy, retinal hemorrhage, visual loss, tinnitus, hearing loss, cardiac arrhythmias, congestive heart failure, interstitial pneumonitis, acute renal failure, bacterial infections (particularly in patients with cirrhosis), and induction or exacerbation of autoimmune diseases, hyperthyroidism, hypothyroidism, acute psychosis, panic attacks, severe depression, and suicide. 2,[10][11][12][13][14][15][16][17][18][19] Healthcare providers should be aware that some of these isolated events have also been reported rarely in association with peginterferon therapy (see package inserts), so that appropriate aggressive investigations may be undertaken when warranted.…”

Section: Uncommon Serious Adverse Eventsmentioning

confidence: 99%

Side effects of therapy of hepatitis C and their management

2002

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Interferon and ribavirin combination therapy for chronic hepatitis C produces a number of well-described side effects that are dominated by fatigue, influenza-like symptoms, hematologic abnormalities, and neuropsychiatric symptoms. Combination therapy with pegylated interferons (peginterferon alfa-2a and alfa-2b) yields an adverse event profile similar to standard interferon, although the frequency of certain adverse events may vary by preparation. Premature withdrawal from therapy due to adverse events was required in 10% to 14% of participants in registration trials of these agents. Most adverse events were safely and effectively managed by dose reduction using predetermined criteria. The most common indications for dose reduction were hematologic abnormalities, such as anemia and neutropenia, with the latter more frequent in peginterferon treatment arms. Recent data suggest that maintaining adherence to a prescribed treatment regimen can enhance antiviral response. Strategies to maximize adherence are being developed and, in the future, may include early identification of and therapy for depression and the selective use of hematopoietic growth factors to ameliorate hematologic abnormalities. (HEPATOLOGY 2002;36: S237-S244.)T he side effect profile of combination therapy using standard interferon and ribavirin has been well described. [1][2][3][4] The major types of side effects include fatigue, influenza-like symptoms, gastrointestinal disturbances, neuropsychiatric symptoms, and hematologic abnormalities. 1,2 These side effects may be treatment limiting and require dose reduction or drug discontinuation. 3,4 Numerous other side effects occur with lower frequencies but may still have an impact on the tolerability of antiviral therapy. 2 Pegylated interferons (peginterferon alfa-2a and peginterferon alfa-2b) have significantly improved pharmacokinetics, 5-8 resulting in improved antiviral efficacy, which also has the potential to alter the side effect profile. This review will focus on the frequency and management of side effects reported with the use of peginterferon and ribavirin for the treatment of chronic hepatitis C based on data from 2 large registration trials that compared these agents with standard interferon and ribavirin combination therapy. Peginterferon Alfa-2a and RibavirinDiscontinuations and Dose Modification. The results of a large phase III clinical trial of peginterferon alfa-2a and ribavirin have been reported recently. 8 More than 1,100 subjects were randomized to therapy with peginterferon alfa-2a and ribavirin, peginterferon alfa-2a and placebo, or standard interferon alfa-2b and ribavirin. Premature withdrawal from therapy due to laboratory abnormalities or adverse events in the combination arms with either peginterferon (10%) or standard interferon (11%) was comparable 8 (Table 1). Interestingly, this rate of discontinuation for either combination arm was lower than previously reported in earlier trials using standard interferon and ribavirin (approximately 20%), 4,9 suggesting improv...

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Section: Uncommon Serious Adverse Eventsmentioning

confidence: 99%

Side effects of therapy of hepatitis C and their management

2002

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“…Altos níveis de fator C5a ativados do complemento podem levar a microinfartos decorrentes da formação de microêmbolos vasculares (13,24) . Esses êmbolos podem envolver raramente vasos de grande calibre e causar oclusões arteriais (16) . O tratamento com o interferon também está associado a risco aumentado de diabetes e hipertrigliceridemia, e pode ser um fator de risco adicional ao estado de hipercoagulabilidade (25) .…”

Section: Relato Do Casounclassified

“…O aparecimento destes sinais teve surgimento mais tardio na paciente deste relato, em comparação com a literatura, cuja média de aparecimento foi de 4 meses após o início da medicação (14) . Outro aspecto interessante a respeito deste caso é a ausência de quaisquer fatores de risco para o desenvolvimento das formas graves da retinopatia pelo interferon: doença vascular retiniana (retinopatia diabética e hipertensiva) (7) ; doenças sistêmicas como diabetes, hipertensão e anemia (7,11,16,28) ; dose inicial de interferon (7) e a freqüência em que eram feitos os exames (pois as hemorragias e os exsudatos são fugazes, desaparecendo em poucas semanas) (14) . Não foram comprovados como fatores de risco os seguintes aspectos: duração do tratamento (14) , alterações laboratoriais de hemograma, contagem de plaquetas e leucócitos (11,14) .…”

Section: Relato Do Casounclassified

“…Alguns pacientes, entretanto, podem desenvolver isquemia por não-perfusão dos capilares retinianos, edema retiniano, extravasamento vascular, anormalidades microvasculares e oclusões, com dano retiniano severo e conseqüente baixa de acuidade visual (13) . Quadros oculares atípicos incluem hemorragia subconjuntival, hemorragia vítrea, glaucoma neovascular, edema do nervo óptico e paralisias oculomotoras (13)(14)16) ; entretanto oclusões de ramo arterial, de ramo venoso ou da veia central da retina, embora bastante infreqüentes, já foram associadas ao uso da terapia com INFα (14,17) . A despeito dos efeitos colaterais com o uso sistêmico de ribavirina incluírem somente lacrimejamento e conjuntivite, essa medicação pode contribuir para a retinopatia em razão de sua ação sinergística, quando utilizada em combinação com o interferon (5,14) .…”

Section: Introductionunclassified

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Trombose de veia central da retina em paciente usuária de interferon e ribavirina: relato de caso

Helal¹,

Zacharias²,

Alencar³

2006

Arq. Bras. Oftalmol.

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Descritores: Hepatite C; Ribavirina/efeitos adversos; Interferon/efeitos adversos; Retinopatia; Oclusão da veia retiniana; Relato de casos [tipo de publicação] INTRODUÇÃOA infecção crônica pelo vírus da hepatite C afeta cerca de 4 milhões de pessoas nos Estados Unidos e aproximadamente 170 milhões em todo o mundo (1)(2) . Somente 15 a 20% destes pacientes apresentam resposta sustentada à terapia com interferon alfa -INFα (3)(4) , mas a combinação da terapia com ribavirina aumenta significativamente esse índice (5)(6) . O INFα, um agrupamento complexo de proteínas, com atividades antivirais, antiproliferativas e imunorregulatórias, é uma droga atualmente utilizada não só no tratamento da hepatite C crônica, mas também de condições sistêmicas, como o sarcoma de Kaposi, os hemangiomas, os melanomas cutâneos e o carcinoma renal metastático (7) . A ribavirina, por sua vez, é um nucleosídio sintético, análogo à guanidina, com propriedades anti-retrovirais contra uma série de DNA e RNA vírus (8) , e também com atividade imunorregulatória (9) . A terapia com INFα é associada a vários efeitos colaterais sistêmicos, como fadiga, mal-estar, perda de peso, depressão, náusea, anorexia, diarréia, neutropenia e trombocitopenia (10)(11)(12) . Em 1993, Guyer e colaboradores descreveram uma forma de retinopatia associada à terapia com interferon, marcada pela presença de exsudatos algodonosos e hemorragias intraretinianas (13) . Desde então, vários relatos demonstraram alterações oculares associadas ao uso desta droga.A retinopatia típica inclui exsudatos algodonosos e hemorragias retiniaTrombose de veia central da retina em paciente usuária de interferon e ribavirina: relato de caso O interferon alfa (INF α) é droga atualmente utilizada no tratamento de várias doenças sistêmicas, como a hepatite C crônica. A ribavirina quando associada ao interferon alfa aumenta muito a resposta ao tratamento. Estima-se que a infecção crônica pelo vírus da hepatite C afete 170 milhões de pessoas no mundo, muitas delas em uso dessas medicações. A forma típica da retinopatia associada ao interferon alfa apresenta exsudatos algodonosos e hemorragias intra-retinianas. Há vários relatos de alterações oculares associadas ao uso do interferon alfa. Este trabalho descreve um caso de oclusão de veia central da retina em olho direito, com hemorragias no olho contralateral, em paciente usuária dessas medicações por dois anos. O caso descrito expõe em um dos olhos o quadro mais freqüente da retinopatia associada ao uso de interferon alfa (hemorragias de fundo) e no olho contralateral, uma apresentação muito mais atípica (trombose de veia central da retina). O quadro fundoscópico apresentou melhora com a interrupção da medicação. RESUMO RELATOS DE CASOS

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“…[5][6][7][8] Among the infrequently reported (1%) prominent serious adverse events associated with standard interferon therapy are retinopathy, retinal hemorrhage, visual loss, tinnitus, hearing loss, cardiac arrhythmias, congestive heart failure, interstitial pneumonitis, acute renal failure, bacterial infections (particularly in patients with cirrhosis), and induction or exacerbation of autoimmune diseases, hyperthyroidism, hypothyroidism, acute psychosis, panic attacks, severe depression, and suicide. 2,[9][10][11][12][13][14][15][16][17][18] Certain adverse events associated with antiviral therapy have been responsible for most dose reductions and discontinuations and also have the greatest potential for altering the quality of life of individuals on antiviral therapy. Specific interventions may be available and deserve further discussion.…”

Section: Introductionmentioning

confidence: 99%

Side effect profile of hepatitis C treatment with peginterferon alpha-2b and ribavarin

Syed

Gul

Rasool

et al. 2017

Int J Basic Clin Pharmacol

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Background: The major types of side effects include fatigue, influenza-like symptoms, gastrointestinal disturbances, neuropsychiatric symptoms and hematologic abnormalities. These side effects may be treatment limiting and require dose reduction or drug discontinuation objectives of the study was to assess the side effect profile of hepatitis C treatment (peginterferon alpha-2b and ribavarin) in Kashmiri patients attending the Department of Gastroenterology skims.Methods: In this study, all consecutive patients of hepatitis C infection on peginterfron and ribavarin treatment were enrolled after written consent. The patients underwent intervention treatment taking pegylated interferon α-2b (Viraferon, Schering Plough Corp., Kenilworth, NJ) and ribavirin in accordance with the standard protocol. Patients were monitored through weekly referrals while taking the medications. A detailed history was taken and complete physical examination done each time the patient presented to the hospital necessary blood sampling was taken.Results: During the study period of 2 years,105 Patients were enrolled 55 (52.4%) were males with a male:female ratio of 1.1:1.0. and mean age 37.6 years with a range of 13-75 years 7 patients (6.6) had a history of needle pricks, 4 patients (2.2%) of sharing same razors at barber’s shop. 4 (3.8%) patients of drug abuse; out of which 3 (2.8%) were intravenous drug abusers, Anemia occurred in 17 (16.2%) patients with requirement of dose modification w in 11 (10.4%) patients and dose stoppage in 1 (0.95%) patient in whom Hb dropped to less than 7, thrombocytopenia occurred in 27 (25.7%) patients with requirement of dose modification in 13 (12.3%) patients and dose stoppage in 1 (0.95%) patients due to platelet count decreasing to less than 30,000. Neutropenia as defined by ANC less than 1500 occurred in 22 (20.9%) patients.Conclusions: Dose modification was required in 48 (45.7%) patients, 30 (28.5%) patients required dose modifications due to labortory abnormalities and 18 (17.1%) due to other side effects. In 8 (7.6%) patients dose was discontinued due to adverse events (including psychosis in 1, severe flu like symptoms in 3, dermatitis in 1, depression in 3).

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Retinal vein thrombosis associated with chronic hepatitis C: a case series and review of the literature

Cited by 44 publications

References 22 publications

Side effects of therapy of hepatitis C and their management

Side effects of therapy of hepatitis C and their management

Trombose de veia central da retina em paciente usuária de interferon e ribavirina: relato de caso

Side effect profile of hepatitis C treatment with peginterferon alpha-2b and ribavarin

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