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Akita S, Fujibayashi K, Ueno EI, Wakasa M, Kawai Y, Kajinami K. Thrombotic Microangiopathy after a 15-year Treatment with Interferon Beta-1b in a Patient with Multiple Sclerosis: A Case Report and Review of Literature. Intern Med 2024; 63:1113-1117. [PMID: 37661454 PMCID: PMC11081907 DOI: 10.2169/internalmedicine.1846-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023] Open
Abstract
A 54-year-old woman with multiple sclerosis treated with interferon-β (IFN-β)-1b for 15 years presented with sustained hypertension (240/124 mmHg) and retinal bleeding. She had proteinuria, anemia, thrombocytopenia, elevated serum creatinine levels, and haptoglobin depletion. Intravenous nicardipine stabilized her blood pressure, but her renal function and platelet count deteriorated. The initial disintegrin-like metalloprotease with thrombospondin type 1 motifs 13 (ADAMTS13) activity was 28% of normal without its inhibitor. The subsequent peripheral appearance of schistocytes suggested thrombotic microangiopathy (TMA). After IFN-β-1b cessation, the platelet count increased, and the blood pressure stabilized. The ADAMTS13 activity normalized, although the creatinine level did not. TMA may develop after the long-term use of IFN-β without adverse events.
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Affiliation(s)
- Satori Akita
- Department of Cardiology, Kanazawa Medical University, Japan
| | | | - Ei-Ichi Ueno
- Department of Cardiology, Kanazawa Medical University, Japan
| | - Minoru Wakasa
- Department of Cardiology, Kanazawa Medical University, Japan
| | - Yasuyuki Kawai
- Department of Cardiology, Kanazawa Medical University, Japan
| | - Kouji Kajinami
- Department of Cardiology, Kanazawa Medical University, Japan
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Mrabet S, Dahmane R, Raja B, Fradi A, Aicha NB, Sahtout W, Azzabi A, Guedri Y, Zellama D, Achour A, Sfar I, Goucha R, Abdessayed N, Mokni M. Thrombotic microangiopathy due to acquired complement factor I deficiency in a male receiving interferon-beta treatment for multiple sclerosis. Br J Clin Pharmacol 2022; 89:1682-1685. [PMID: 36480744 DOI: 10.1111/bcp.15631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
AIMS Interferon-beta (IFNβ), the most widely prescribed medication for multiple sclerosis, is generally considered safe. Nevertheless, rare serious and/or life-threatening side effects have been reported such as thrombotic microangiopathy. A few mechanisms have been proposed to explain how interferon causes thrombotic microangiopathy, but immunological studies have been unable to pin this phenomenon down to a single pathophysiologic pathway. The aim of this article was to report a new mechanism explaining Interferon beta related thrombotic microangiopathy. METHODS We report thrombotic microangiopathy in a 28-year-old male receiving interferon-beta treatment for multiple sclerosis. RESULTS After three years of starting interferon beta therapy, the patient presented with malignant hypertension causing seizures, rapidly progressive renal failure requiring haemodialysis and haemolytic anaemia. Corticosteroid and plasma exchange sessions permitted haemolysis control. Nonetheless, the patient remained hemodialysis-dependent. Exploration of the complement system found a complement factor I deficiency whose activity normalized at the control carried out after 2 years. CONCLUSION IFNβ treatment may cause complement factor I deficit, which can lead to thrombotic microangiopathy and severe renal failure.
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Affiliation(s)
- Sanda Mrabet
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Rihem Dahmane
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Boukadida Raja
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Asma Fradi
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Narjess Ben Aicha
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Wissal Sahtout
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Awatef Azzabi
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Yosra Guedri
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Dorsaf Zellama
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Abdellatif Achour
- Department of Nephrology, Dialysis, and Transplantation, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Imen Sfar
- Laboratory of immunology Charles Nicolle Hospital, El Manar University, Tunis, Tunisia
| | - Rim Goucha
- Department of Nephrology, Dialysis, and Transplantation La Marsa Hospital, El Manar University, Tunis, Tunisia
| | - Nihed Abdessayed
- Department of Pathology, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
| | - Moncef Mokni
- Department of Pathology, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Sahloul, Sousse, Tunisia
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Samuel E, McNaught KA, Mulbah JL, HajiAlilou H, Mody V, Cates DW. Antiviral drugs. SIDE EFFECTS OF DRUGS ANNUAL 2022. [PMCID: PMC9597564 DOI: 10.1016/bs.seda.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this chapter, we have reviewed side effects reported with the use of antivirals for the treatment of the following infections: coronavirus disease 2019 (COVID-19), cytomegalovirus (CMV), hepatitis B virus (HBV), hepatitis C Virus (HCV), herpes simplex viruses 1 and 2 (HSV-1, -2), human immunodeficiency virus (HIV), and influenza virus. The search engines PUBMED, EMBASE and International Pharmaceutical Abstracts (IPA) were utilized to identify literature published between January 1, 2021 to December 31, 2021.
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Affiliation(s)
- Essie Samuel
- Department of Pharmacy Practice, PCOM Georgia School of Pharmacy, Suwanee, GA, United States,Corresponding author:
| | - Krysten A. McNaught
- Department of Pharmacy Practice, PCOM Georgia School of Pharmacy, Suwanee, GA, United States
| | - Jessica L. Mulbah
- Department of Pharmacy Practice, PCOM Georgia School of Pharmacy, Suwanee, GA, United States
| | - Hazhir HajiAlilou
- Department of Pharmaceutical & Biomedical Sciences, PCOM Georgia School of Pharmacy, Suwanee, GA, United States
| | - Vicky Mody
- Department of Pharmaceutical & Biomedical Sciences, PCOM Georgia School of Pharmacy, Suwanee, GA, United States
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Taghavi M, Stordeur P, Collart F, Dachy B, Pozdzik A, Carmo Filomena Mesquita MD, Nortier J. Interferon-beta1a-induced thrombotic microangiopathy: Possible implication of the alternative pathway of the complement. Kidney Int Rep 2022; 7:1917-1921. [PMID: 35967109 PMCID: PMC9366298 DOI: 10.1016/j.ekir.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
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Allinovi M, Bellinvia A, Pesce F, Milan Manani S, Razzolini L, Brezzi B, Protopapa P, Mantero V, Caroti L, Cirami CL, Amato MP, Del Vecchio L. Safety and Efficacy of Eculizumab Therapy in Multiple Sclerosis: A Case Series. Brain Sci 2021; 11:1341. [PMID: 34679405 PMCID: PMC8533854 DOI: 10.3390/brainsci11101341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Complement system activation has been proposed as one of the different factors that contribute to Multiple Sclerosis (MS) pathogenesis. In this study, we aimed to describe the potential effects of eculizumab, an anticomplement therapy, on MS disease activity in a cohort of relapsing-remitting (RR) MS patients who discontinued IFN-β therapy due to IFN-β-related thrombotic microangiopathy (TMA) onset. (2) Methods: In this retrospective observational multicentric study, we searched for all patients with MS treated by eculizumab with a survey of several nephrological and neurological centers (over 45 centers). (3) Results: Nine patients were included. The mean follow-up time under eculizumab was 3.72 ± 2.58 years. There were no significant differences in disease activity (EDSS, relapses, new T2, and/or Gd-enhancing lesions at MRI) considering the two years before and after eculizumab therapy. No adverse events potentially related to eculizumab therapy were reported during follow-up. (4) Conclusions: In this preliminary study, we described a good safety profile for eculizumab therapy in MS. However, the available data are not sufficient to make firm conclusions about the possible efficacy of eculizumab as a disease-modifying therapy for MS patients.
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Affiliation(s)
- Marco Allinovi
- Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, 50139 Florence, Italy; (L.C.); (C.L.C.)
| | - Angelo Bellinvia
- NEUROFARBA Department, University of Florence, 50139 Florence, Italy; (A.B.); (L.R.); (M.P.A.)
| | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, 70121 Bari, Italy; (F.P.); (P.P.)
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, 36100 Vicenza, Italy;
| | - Lorenzo Razzolini
- NEUROFARBA Department, University of Florence, 50139 Florence, Italy; (A.B.); (L.R.); (M.P.A.)
| | - Brigida Brezzi
- Division of Nephrology and Dialysis, SS Antonio e Biagio e C. Arrigo Hospital, 15121 Alessandria, Italy;
| | - Paolo Protopapa
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, 70121 Bari, Italy; (F.P.); (P.P.)
| | - Vittorio Mantero
- MS Center, Department of Neurology, ASST Lecco, 23900 Lecco, Italy;
| | - Leonardo Caroti
- Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, 50139 Florence, Italy; (L.C.); (C.L.C.)
| | - Calogero Lino Cirami
- Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, 50139 Florence, Italy; (L.C.); (C.L.C.)
| | - Maria Pia Amato
- NEUROFARBA Department, University of Florence, 50139 Florence, Italy; (A.B.); (L.R.); (M.P.A.)
- IRCCS Don Carlo Gnocchi, 50143 Florence, Italy
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Parisi M, Manni A, Caputo F, Trojano M, Paolicelli D. A case report of late-onset atypical Hemolytic Uremic Syndrome during interferon beta in multiple sclerosis: Open issues in literature review. Brain Behav 2021; 11:e01930. [PMID: 33325640 PMCID: PMC7821561 DOI: 10.1002/brb3.1930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND AIMS Interferon beta (IFNβ) is a well-established first-line therapy for relapsing-remitting multiple sclerosis (RRMS) patients and remains the most widely prescribed agent. Atypical hemolytic uremic syndrome (aHUS) represents a rare but severe adverse effect (AE) that could occur even after many years from the beginning of IFNβ therapy. Eculizumab is currently approved for treatment of aHUS and recently for neuromyelitis optica spectrum disorder (NMOSD) with aquaporin-4 antibodies (AQP4-IgG). In this article, we report the case of the latest onset of IFNβ-related aHUS experienced by an MS patient and we briefly review the literature on this topic. METHODS We performed a systematic review of the literature using PubMed, and we performed a retrospective analysis of RRMS patients that received IFNβ-1a in our center and developed thrombotic microangiopathy (TMA). From this search, we identified only one patient. RESULTS In the published literature, we identified 24 MS patients who received IFNβ as disease-modifying treatment (DMT) and then developed thrombotic microangiopathy with kidney injury. The aHUS has been diagnosed in 6, all received IFNβ-1a and the latest onset was after 15 years. We report a case of a 39-year-old man affected by RRMS who assumed IFNβ-1a since 1999. In July 2018, he developed an IFNβ-related aHUS. After the failure of plasma exchange, he underwent eculizumab, with an improvement of glomerular filtration rate and without new signs of MS activity. CONCLUSION To our knowledge, this case represents the latest onset of IFNβ-related aHUS in MS patients. Up to now, there are not literary reports about the possibility to reintroduce a DMT as add-on therapy to eculizumab.
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Affiliation(s)
- Mosè Parisi
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Alessia Manni
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Francesca Caputo
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Damiano Paolicelli
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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