Ursodeoxycholic acid exacerbates peginterferon-induced interstitial pneumonia in a patient with hepatitis C

Abstract

Pegylated interferon alpha combined with ribavirin is currently the standard treatment for hepatitis C virus (HCV) infection. Ursodeoxycholic acid (UDCA) is used as a complementary treatment in patients who are non-responders or who develop severe side effects of this combined therapy. UDCA is generally considered to be a relatively safe drug. However, we recently encountered a patient with chronic hepatitis C in whom interferon-induced interstitial pneumonia was exacerbated by UDCA. This patient responded to initial antiviral therapy with non-pegylated interferon alpha-2b and ribavirin, but hepatitis recurred soon after the end of treatment. A second course of antiviral therapy using peginterferon alpha-2b and ribavirin achieved normalization of serum transaminases and HCV-RNA, but also caused interstitial pneumonia. After discontinuing peginterferon, this side effect was ameliorated. On the other hand, hepatitis relapsed four months later. UDCA treatment was started and serum transaminase levels decreased, but exacerbation of interstitial pneumonia occurred with marked elevation of the serum KL-6 level. To our knowledge, this is the first reported case of peginterferon-induced interstitial pneumonia showing exacerbation due to UDCA therapy.

Side Effects of Cytokines Approved for Therapy

“…Pegylated interferon alfa-2b has been associated with acute myocardial infarction [134], pericarditis [135], pericardial effusion with tamponade [136] and sick sinus syndrome producing arrhythmias [137] and an orthotopic heart transplant patient died after allograft failure with death attributed to interferon toxicity [138]. Interstitial lung disease, reported for both interferon alfa-2a and 2b [139][140][141][142][143][144], is seen more frequently with the former agent and with high doses of the latter [145]. Potentially fatal interstitial pneumonitis [146], secondary to interferon alfa-ribavirin therapy for hepatitis C infection, is said to have an incidence of 0.03-0.3 % although an incidence of *1.1 % was found in 558 Japanese patients [147].…”