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Retinal toxicities of systemic anticancer drugs. Surv Ophthalmol 2021; 67:97-148. [PMID: 34048859 DOI: 10.1016/j.survophthal.2021.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 01/07/2023]
Abstract
Newer anticancer drugs have revolutionized cancer treatment in the last decade, but conventional chemotherapy still occupies a central position in many cancers, with combination therapy and newer methods of delivery increasing their efficacy while minimizing toxicities. We discuss the retinal toxicities of anticancer drugs with an emphasis on the mechanism of toxicity. Uveitis is seen with the use of v-raf murine sarcoma viral oncogene homolog B editing anticancer inhibitors as well as immunotherapy. Most of the cases are mild with only anterior uveitis, but severe cases of posterior uveitis, panuveitis, and Vogt-Koyanagi-Harada-like disease may also occur. In the retina, a transient neurosensory detachment is observed in almost all patients on mitogen-activated protein kinase kinase (MEK) inhibitors. Microvasculopathy is often seen with interferon α, but vascular occlusion is a more serious toxicity caused by interferon α and MEK inhibitors. Crystalline retinopathy with or without macular edema may occur with tamoxifen; however, even asymptomatic patients may develop cavitatory spaces seen on optical coherence tomography. A unique macular edema with angiographic silence is characteristic of taxanes. Delayed dark adaptation has been observed with fenretinide. Interestingly, this drug is finding potential application in Stargardt disease and age-related macular degeneration.
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Elgouhary SM, Said-Ahmed KE, Mowafy MA. Anatomical and Functional Retinal Complications of Combined Sofosbuvir and Ribavirin Therapy in Patients With Chronic Hepatitis C Virus. Ophthalmic Surg Lasers Imaging Retina 2019; 50:39-41. [PMID: 30640394 DOI: 10.3928/23258160-20181212-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/02/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the anatomical and functional retinal complications of combined sofosbuvir and ribavirin therapy in patients with chronic hepatitis C virus (HCV). PATIENTS AND METHODS Three hundred patients with chronic HCV were recruited for this prospective, observational study from the National Liver Institute of Menoufia University from November 2015 to September 2017. Ophthalmic examination and follow-up were performed in the outpatient clinic of the Ophthalmology Department at Menoufia University. All patients received the same regimen (sofosbuvir and ribavirin) for 6 months. Patients were followed up during the period of treatment (6 months) and for 6 months after treatment completion. Complete ophthalmic examination, fundus fluorescein angiography (FFA) (to detect retinal ischemia), optical coherence tomography (OCT) (to detect retinal nerve fiber layer [RNFL] thickness and central macular thickening), and electroretinogram (ERG) (to detect rod and cone functions) tests were performed before and after treatment completion. RESULTS The mean age of the patients was 46.17 years ± 11.38 years (range: 20 years to 60 years). The study included 138 men (46%) and 162 women (54%). During follow-up, there were no signs of retinopathy or optic nerve affection. There were also no signs of retinal ischemia (by FFA), RNFL affection, macular edema (by OCT), or rod or cone affection (by ERG). CONCLUSION Combined treatment (sofosbuvir and ribavirin) may be safe without causing anatomical or functional retinal complications. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:39-42.].
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Visual and brainstem auditory evoked potentials in HCV-infected patients before and after interferon-free therapy - A pilot study. Int J Infect Dis 2019; 80:122-128. [PMID: 30641198 DOI: 10.1016/j.ijid.2019.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/02/2019] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate brain bioelectrical activity disturbances in HCV-positive patients before and 24 weeks after interferon-free therapy (DAA), using visual (VEP) and brainstem (BAEP) evoked potentials and advanced magnetic resonance techniques. MATERIALS AND METHODS 11 HCV-infected patients (6 women, 5 men, mean age 51 years old) and 30 healthy controls, sex and age-matched, were studied. Clinical neurological examinations, VEP, BAEP, diffusion tensor imaging (DTI) and perfusion weighted imaging (PWI) were performed. RESULTS 11 patients achieved a sustained viral response, and liver fibrosis regression in APRI and in elastography were observed. The mean P100 latency was significantly shorter in HCV-patients after therapy compared to the values before treatment (p<0.05). The mean wave BAEP V latency and I-V interpeak latency were significantly longer in the HCV-infected patients before therapy compared to HCV-patients after therapy. CONCLUSIONS This study confirms that treatment with DAA in patients with chronic HCV infection positively affects the bioelectrical activity of the brain. An increase in the amplitude of EP after treatment indicates an improvement in the activity of the cerebral cortex. EP examination may be a useful method of assessing the function of the nervous system before and after antiviral treatment.
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Köşkderelioğlu A, Ortan P, Ari A, Gedizlioğlu M. Screening for Electrophysiological Abnormalities in Chronic Hepatitis C Infection: Peripheral Neuropathy and Optic Neuropathy. Noro Psikiyatr Ars 2016; 53:23-27. [PMID: 28360761 DOI: 10.5152/npa.2015.10218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/11/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION To investigate the existence of peripheral and optic neuropathies in asymptomatic individuals with hepatitis C infection. METHODS Thirty consecutive patients who were followed in a hepatitis C outpatient clinic were recruited for electrophysiological evaluation together with 30 age- and gender-compatible healthy controls. All patients had a detailed neurological examination. The information regarding the disease duration and management with interferons were collected. Nerve conduction studies and visual evoked potentials (VEP) were recorded in all subjects. The results of the patient and control groups were statistically compared. RESULTS Of the patients with hepatitis C infection, 16 were females and 14 males. The mean age was 57.5 years, and the average disease duration was 6.43 years. The P100 latencies in the patient group were within normal limits, while the amplitudes were meaningfully small by comparison with the controls. There were some abnormalities in the nerve conduction studies of 15 patients. Sensorial neuropathy was detected in two patients, sensorimotor polyneuropathy in four, carpal tunnel syndrome in seven, and carpal tunnel syndrome and sensorimotor polyneuropathy as comorbid states in another two patients. The nerve conduction studies and VEP parameters were entirely normal in the control group. CONCLUSION Hepatitis C-related neurological abnormalities may occur both in the central and peripheral nervous system. Mononeuritis multiplex, sensorial axonal neuropathy, and multiple mononeuropathies are some of the presentations of the peripheral nervous system involvement. The mode of infection is considered to be via vasculitic mechanisms. In addition, optic neuropathy is a known complication of interferon treatment. Autoantibodies, cytokines, chemokines, and cryoglobulins are accused to play roles in the pathogenesis. In this study, we investigated the involvement of the peripheral nervous system and optic nerves in a group of patients with hepatitis C. The results were in favor of peripheral nerve injury of various types and optic neuropathy of the axonal type.
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Affiliation(s)
- Aslı Köşkderelioğlu
- Clinic of Neurology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Pınar Ortan
- Clinic of Neurology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Alpay Ari
- Clinic of Infectious Diseases, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Muhteşem Gedizlioğlu
- Clinic of Neurology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
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Iferkhass S, Elasri F, Chatioui S, Khoyaali A, Bargach T, Reda K, Oubaaz A. [Bilateral non-arteritic ischemic optic neuropathy during treatment of viral hepatitis C with pegylated interferon and Ribavirin]. J Fr Ophtalmol 2014; 38:34-40. [PMID: 25533994 DOI: 10.1016/j.jfo.2014.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 05/22/2014] [Accepted: 06/16/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hepatitis C is a serious viral infection, for which the current treatment is based on the combination of pegylated interferon (IFN) and Ribavirin(®). Ophthalmic complications observed with PEG-IFN are infrequent and of variable prognosis. They often include an ischemic retinopathy with typical cotton-wool spots, hemorrhage and retinal edema, and rarely acute non-arteritic anterior ischemic optic neuropathy as illustrated by our report. OBSERVATION We report the case of a 51-year-old man followed for chronic active hepatitis C, who presented in the fourth month of treatment with pegylated interferon and vidarabine with a sharp decline in visual acuity secondary to acute bilateral non-arteritic anterior ischemic optic neuropathy. The hepatitis C treatment was discontinued. His course was notable by the third week for a significant regression of papilledema with improvement in visual acuity in the right eye and no change in the left eye, remaining at counting fingers. After regressing for four years, the disease progressed to bilateral temporal optic atrophy without change in visual acuity. CONCLUSION Pegylated interferon and Ribavirin(®) are commonly used in the treatment of chronic hepatitis C. They are the source of various ophthalmologic complications of varied severity. The pathophysiology of this ocular toxicity currently remains hypothetical. Non-arteritic ischemic optic neuropathy is still a relatively rare complication with a poor functional prognosis, often requiring discontinuation of treatment. Thus, careful ophthalmologic monitoring before and during antiviral treatment of patients with hepatitis C appears necessary.
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Affiliation(s)
- S Iferkhass
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc.
| | - F Elasri
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - S Chatioui
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - A Khoyaali
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - T Bargach
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - K Reda
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
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Sellner J, Steiner I. Neurologic complications of hepatic viruses. HANDBOOK OF CLINICAL NEUROLOGY 2014; 123:647-61. [PMID: 25015509 DOI: 10.1016/b978-0-444-53488-0.00031-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Johann Sellner
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universität Munich, Germany
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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McCarthy M, Ortega MR. Neurological complications of hepatitis C infection. Curr Neurol Neurosci Rep 2012; 12:642-54. [PMID: 22991069 DOI: 10.1007/s11910-012-0311-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Though well-known as a cause of liver disease, Hepatitis C virus infection is emerging as a cause of a variety of peripheral and central nervous system disorders. The virus causes chronic persistent infection with complex immune responses in the majority of individuals. Viral infection may have the potential to generate neurological illness through direct infection of neural cells or through immune-mediated mechanisms, including enhancement of autoimmune responses. Moreover, the mainstay of antiviral treatment of hepatitis C infection, interferon-alpha, is itself associated with neurological morbidity. Thus neurologists are increasingly faced with diagnosing or even predicting a wide spectrum of neurological complications of hepatitis C infection and/or its treatment.
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Affiliation(s)
- Micheline McCarthy
- Neurology (127), Bruce Carter Veterans Affairs Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA.
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Abd El-Badie Mohamed M, Abd-El azeem Eed K. Retinopathy associated with interferon therapy in patients with hepatitis C virus. Clin Ophthalmol 2012; 6:1341-5. [PMID: 22969278 PMCID: PMC3429287 DOI: 10.2147/opth.s32469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate retinopathy associated with interferon therapy in patients with chronic hepatitis C. METHODS One hundred patients with chronic hepatitis C undergoing interferon therapy were examined for the presence of cotton wool spots, retinal hemorrhages, cystoid macular edema, capillary non-perfusion, and arteriolar occlusion. Complete ophthalmological examination including indirect ophthalmoscopic fundus examination was carried out for all patients and colored fundus photography and fluorescein angiography were carried out for the patients with positive fundus findings. The follow-up period was 9 months. RESULTS Sixteen percent of patients developed retinopathy in the form of cotton wool spots, retinal hemorrhages, cystoid macular edema, and capillary non-perfusion. CONCLUSION Interferon therapy can lead to retinopathy which is mostly reversible and dose related. Periodic fundoscopic examinations help in early detection and prevent progression to permanent visual loss.
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Affiliation(s)
| | - Khaled Abd-El azeem Eed
- Gastroentrology and Hepatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
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Calvaruso V, Mazza M, Almasio PL. Pegylated-interferon-α(2a) in clinical practice: how to manage patients suffering from side effects. Expert Opin Drug Saf 2011; 10:429-35. [PMID: 21323500 DOI: 10.1517/14740338.2011.559161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The goal of antiviral therapy in patients with chronic hepatitis C is to slow or halt the progression of fibrosis and prevent the development of cirrhosis. Accordingly, antiviral treatment is proposed for a large population of patients with chronic hepatitis. AREAS COVERED The standard-of-care for chronic hepatitis C is the combination of pegylated IFN (PEG-IFN) and ribavirin. The use of these drugs has been correlated with a range of adverse effects, including influenza-like symptoms, hematological changes and neuropsychiatric disturbances. The effects of these adverse events associated with PEG-IFN therapy are manifold and are a major reason why patients decline or stop therapy. This review addresses the screening for adverse event risk factors and guides the patient to success with adherence strategies. EXPERT OPINION Knowledge of the side effects correlated with PEG-IFN is very relevant for clinicians because it can allow them to arrange the best methods for treating these effects and avoid the discontinuation of antiviral treatment. Moreover, the use of new antiviral drugs will considerably shorten treatment periods reducing many of the above-described side effects and, thus, increase adherence to scheduled therapy.
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Affiliation(s)
- Vincenza Calvaruso
- University of Palermo, Gastroenterology & Hepatology Unit, Dipartimento Biomedico di Medicina Interna e Specialistica, Piazza delle Cliniche, 2, 90127 Palermo, Italy
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Ophthalmologic complications in children with chronic hepatitis C treated with pegylated interferon. J Pediatr Gastroenterol Nutr 2010; 51:183-6. [PMID: 20512062 PMCID: PMC2910798 DOI: 10.1097/mpg.0b013e3181b99cf0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Interferon treatment for chronic viral hepatitis C (HCV) has been associated with the development of retinopathy in 19% to 29% of adults. Our purpose is to describe the ophthalmologic complications of pegylated interferon-alpha2a with either placebo or ribavirin in children with chronic HCV (the PEDS-C trial). MATERIALS AND METHODS Prospective, comprehensive ophthalmologic examinations including slit lamp at enrollment and after 24 and 48 weeks of treatment of 114 children participating in a randomized clinical trial. RESULTS One hundred and twenty-eight children were screened for entry, of whom 123 had an eye examination and no child had existing retinal disease. One hundred fourteen children were eligible and were treated. One hundred ten children had an eye examination at 24 weeks and 103 children at 48 weeks. Three of 114 subjects (2.6%) developed documented (n = 2) or possible (1) serious eye complications. One subject developed evidence of ischemic retinopathy (cotton-wool spots) by week 24, 1 developed uveitis by week 48, and 1 reported at week 48 transient (<4 hours) monocular blindness that had occurred at week 36 with a subsequent normal examination at week 48. CONCLUSIONS Ophthalmologic complications are infrequent in children who are treated with pegylated interferon-alpha2a for HCV (2%-3%). Because of the potential severity of ischemic retinopathy and uveitis, prospective ocular assessment should remain part of the monitoring strategy for children who are treated with interferon for HCV.
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Peponis V, Kyttaris VC, Chalkiadakis SE, Bonovas S, Sitaras NM. Ocular side effects of anti-rheumatic medications: what a rheumatologist should know. Lupus 2010; 19:675-82. [PMID: 20144965 DOI: 10.1177/0961203309360539] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nearly every drug may cause changes to ocular tissues through a variety of mechanisms. Medication overdoses, drug-drug interactions but also chronic administration of medications at the recommended doses may lead to ocular toxicity. The ocular side effects, screening for eye toxicity and treatment guidelines for anti-inflammatory and immunosuppressive drugs commonly used by rheumatologists are reviewed herein.
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Affiliation(s)
- V Peponis
- Athens Eye Hospital, Second Eye Clinic, Athens, Greece
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12
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Kang HM, Park MJ, Hwang JM, Kim JW, Jeong SH. Development of ocular myasthenia during pegylated interferon and ribavirin treatment for chronic hepatitis C. THE KOREAN JOURNAL OF HEPATOLOGY 2009; 15:209-15. [PMID: 19581773 DOI: 10.3350/kjhep.2009.15.2.209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A 63-year-old male experienced sudden diplopia after 9 weeks of administration of pegylated interferon (IFN) alpha-2b and ribavirin for chronic hepatitis C (CHC). Ophthalmologic examinations showed ptosis on the right upper lid and restricted right eye movement without any other neurological signs. A brain imaging study and repetitive nerve stimulation test indicated no abnormality. The acetylcholine receptor antibody titer and response to acetylcholinesterase inhibitors were negative, and the results of thyroid function tests were normal. The patient's ophthalmological symptoms improved rapidly 3 weeks after discontinuation of pegylated IFN alpha-2b and ribavirin. The ocular myasthenia associated with combination therapy of pegylated IFN alpha-2b and ribavirin for CHC is very rarely reported; therefore, we present this case with a review of the various eye complications of IFN therapy.
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Affiliation(s)
- Hyung Min Kang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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13
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Panetta JD, Gilani N. Interferon-induced retinopathy and its risk in patients with diabetes and hypertension undergoing treatment for chronic hepatitis C virus infection. Aliment Pharmacol Ther 2009; 30:597-602. [PMID: 19549263 DOI: 10.1111/j.1365-2036.2009.04071.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ocular complications are amongst many side-effects of interferon based therapy for hepatitis C virus (HCV) infection. Some suggest that diabetic and hypertensive patients are at increased risk of these complications. AIM To determine the frequency of ophthalmological complications related to interferon use. METHODS Retrospective analysis of patients undergoing HCV treatment with pegylated interferon alpha-2a, alpha-2b or consensus interferon plus ribavirin between 2005 and 2007. All patients underwent a baseline eye examination and any visual complaints during treatment prompted a repeat examination. Data recorded included HCV genotype, treatment duration, interferon type, pre-treatment and on treatment visual complaints, known ocular pathology, and retinal findings at baseline and at follow-up. RESULTS Of 183 patients, 29 (16%) had diabetes and 85 (46%) had hypertension. Seventy-one (38%) received interferon alpha-2a, 100 (55%) alpha-2b, and 12 (7%) consensus interferon. Seven (3.8%) had retinal changes on follow-up and treatment was discontinued in 3 (1.6%). Of seven with ocular changes two had hypertension and one had both hypertension and diabetes. CONCLUSION The incidence of symptomatic retinopathy in HCV patients undergoing interferon therapy appears low and treatment cessation is rarely needed. Furthermore, patients with hypertension and diabetes may not be at higher risk for interferon-induced retinopathy.
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Affiliation(s)
- J D Panetta
- Department of Gastroenterology and Hepatology, Phoenix VA Healthcare System, Phoenix, AZ 85012, USA
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Hashemi N, Rossi S, Navarro VJ, Herrine SK. Safety of peginterferon in the treatment of chronic hepatitis C. Expert Opin Drug Saf 2009; 7:771-81. [PMID: 18983223 DOI: 10.1517/14740330802423291] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Combination of 'pegylated' interferons (IFNs) plus ribavirin, the standard treatment of chronic hepatitis C (CHC), is frequently associated with side effects. Anticipation, recognition and proper management of these side effects are important to ensure compliance with therapy and achievement of sustained virologic response. OBJECTIVE To illustrate the side effect profile of pegIFN-alpha in the treatment of CHC. METHODS Studies and abstracts were identified through a computerized, English language literature search. Key search terms included peginterferon and CHC. Information available only in abstract form was retrieved from national and international hepatology associations. RESULTS Most adverse events occurring with combination therapy can be anticipated and managed appropriately; therefore, premature discontinuation of therapy owing to side effects is not required in most patients.
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Affiliation(s)
- Nikroo Hashemi
- Thomas Jefferson University, Division of Gastroenterology and Hepatology, Philadelphia, PA, USA
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15
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Petzold A, Plant GT. Central and Paracentral Visual Field Defects and Driving Abilities. Ophthalmologica 2008; 219:191-201. [PMID: 16088237 DOI: 10.1159/000085727] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 08/19/2004] [Indexed: 12/29/2022]
Abstract
The effect of central and paracentral visual field defects on driving abilities has until now received little attention. To date studies and surveys have concentrated on visual acuity and peripheral field loss. Here we summarise for the first time those diseases causing central visual field defects likely to be associated with binocular visual acuity adequate for driving.
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Affiliation(s)
- A Petzold
- Department of Neuroimmunology, Institute of Neurology, London, UK.
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Yan KKL, Dinihan I, Freiman J, Zekry A. Sarcoidosis presenting with granulomatous uveitis induced by pegylated interferon and ribavirin therapy for Hepatitis C. Intern Med J 2008; 38:207-10. [PMID: 18290816 DOI: 10.1111/j.1445-5994.2007.01625.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sarcoidosis is a systemic granulomatous disease that is triggered by an autoimmune process, and is now a well recognized but uncommon complication of antiviral therapy for Hepatitis C virus (HCV) infection, likely related to its immunomodulatory effects. The clinical presentation of HCV related sarcoidosis is as varied as systemic sarcoidosis, but ocular presentation alone has not been reported previously. We present a 23 year-old female who developed visual disturbances due to ocular sarcoidosis during the course of antiviral therapy for chronic HCV infection. Our case presentation is then followed by a review of the literature on the topic. We aim to stress the importance of screening for eye problems in following HCV patients undergoing antiviral therapy, and raise clinicians' awareness of sarcoidosis as a possible cause for eye problems even in the absence of respiratory complaints.
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Affiliation(s)
- K K L Yan
- Department of Gastroenterology, St George Hospital, University of New South Wales, Sydney, New South Wales, Australia
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17
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Sene D, Touitou V, Bodaghi B, Saadoun D, Perlemuter G, Cassoux N, Piette JC, Hoang PL, Cacoub P. Intraocular complications of IFN-α and ribavirin therapy in patients with chronic viral hepatitis C. World J Gastroenterol 2007; 13:3137-40. [PMID: 17589934 PMCID: PMC4172625 DOI: 10.3748/wjg.v13.i22.3137] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a panel of severe inflammatory and vascular intraocular disorders occurring during interferon-alpha (IFN-α) treatment in eight hepatitis C virus (HCV)-infected patients. These events include three cases of Vogt-Koyanagi-Harada like (VKH) disease (an association of panuveitis, retinal detachment, ear and meningeal detachment and skin and hair changes), two cases of central retinal vein occlusion, one case of central retinal artery occlusion, one case of severe hypertensive retinopathy and one case of bilateral ischemic optic neuropathy with severe visual impairment. Rare as they are, such severe ophthalmological complications require a close follow-up of HCV-infected patients under IFN-α treatment with ophthalmological monitoring if any ocular manifestation occurs.
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Affiliation(s)
- Damien Sene
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
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Andrade RJ, González FJ, Vázquez L, Cilvetti A, Camargo R, García-Cortés M, Martos-VanDussen JV, Rosón P, Lucena MI, Clavijo E. Vascular Ophthalmological Side Effects Associated with Antiviral Therapy for Chronic Hepatitis C are Related to Vascular Endothelial Growth Factor Levels. Antivir Ther 2006. [DOI: 10.1177/135965350601100403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have screened for the incidence of vascular ophthalmological side effects (VOSE) in chronic hepatitis C (CHC) patients undergoing pegylated interferon (peg-IFN) plus ribavirin (RBV) therapy and sought evidence for angiogenesis activation. Thirty-four CHC patients were prospectively evaluated (18 patients with 180 μg/week of peg-IFN-α2a plus 800 mg/day of RBV and 16 with 1.5μg/kg/week of peg-IFN-α2b plus 800–1,200 mg/day of RBV). Complete ophthalmological evaluation and serum vascular endothelial growth factor (VEGF) levels were assessed before and at the end of therapy. Thirteen patients (38.2%) developed VOSE, eight (23.5%) featured subconjunctival haemorrhage, and five (14.7%) had evidence of retinopathy – all were unrelated to age, sex, genotype, the type of antiviral schedule used and response to therapy. At the end of treatment, the VOSE group had significantly higher serum VEGF levels than the group of patients without detectable side effects (median 281 [range 106–386] vs 117 [83–225] pg/ml, P=0.05). These differences increased when VEGF values were corrected by platelet count. In the VOSE group, baseline VEGF and VEGF/platelet values were also significantly higher (164 [55–260] vs 64 [21–172] pg/ml, P=0.046; and 0.920 [0.217–1.543] vs 0.320 [0.100–0.661] pg/106 platelets, P=0.024, respectively]. In a multivariate model VEGF/platelet values at end of treatment and hepatic fibrosis stage were the only predictors of VOSE development. In 3 out of 13 patients visual acuity was affected and 2 had residual lesions in the follow-up. In this exploratory study, antiviral therapy of CHC frequently induces VOSE, apparently through an activation of angiogenesis.
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Affiliation(s)
- Raúl J Andrade
- Liver Unit, University Hospital and School of Medicine, Málaga, Spain
| | - F Jesús González
- Oncology Unit, University Hospital and School of Medicine, Málaga, Spain
- Institute of Biopathology and Regenerative Medicine (IBIMER), University of Granada, Granada, Spain
| | - Luis Vázquez
- Liver Unit, University Hospital and School of Medicine, Málaga, Spain
| | - Angel Cilvetti
- Ophthalmology Unit, University Hospital and School of Medicine, Málaga, Spain
| | - Raquel Camargo
- Liver Unit, University Hospital and School of Medicine, Málaga, Spain
| | | | | | - Pedro Rosón
- Liver Unit, University Hospital and School of Medicine, Málaga, Spain
| | - M Isabel Lucena
- Clinical Pharmacology Services, ‘Virgen de la Victoria’ University Hospital and School of Medicine, Málaga Spain
| | - Encarnaciòn Clavijo
- Microbiology Unit, ‘Virgen de la Victoria’ University Hospital and School of Medicine, Málaga Spain
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d'Alteroche L, Majzoub S, Lecuyer AI, Delplace MP, Bacq Y. Ophthalmologic side effects during alpha-interferon therapy for viral hepatitis. J Hepatol 2006; 44:56-61. [PMID: 16223542 DOI: 10.1016/j.jhep.2005.07.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 07/13/2005] [Accepted: 07/15/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS Ophthalmologic side effects have been reported during interferon therapy, particularly retinal lesions and neurovisual impairment. The aim of this prospective study was to assess the nature and the frequency of such lesions during alpha-interferon therapy for viral hepatitis. METHODS Between 1995 and 2003, 156 patients treated with standard or pegylated alpha-interferon, with or without ribavirin, had a regular ophthalmologic examination before and during treatment. No patient had signs of retinopathy before treatment. Cotton-wool spots were found in 31 patients and retinal hemorrhage in nine patients during treatment (24% of patients). These lesions remained asymptomatic and disappeared in all patients. A previous history of arterial hypertension (RR 4.60, 95% CI 1.95-10.85), age above 45 years (RR 2.80, 95% CI 1.36-5.85), and use of pegylated alpha-interferon (RR 2.75, 95% CI 1.41-5.38) were significantly associated with retinopathy. Neurovisual impairment was present in 31 patients (20%) before treatment and in 74 patients (47%) during treatment. CONCLUSIONS In conclusion, this study showed that signs of retinopathy and neurovisual impairment were common in patients receiving alpha-interferon therapy but were rarely symptomatic. It suggests that alpha-interferon may usually be continued in asymptomatic patients as long as there is careful fundoscopic examination.
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Affiliation(s)
- Louis d'Alteroche
- Service d'Hépato-Gastroentérologie, Hôpital Trousseau, 37044 Tours cedex, France.
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Yaghi C, Baz P, Koussa S, Daniel F, Haddad F, Sayegh R. Neuropathie optique ischémique antérieure aiguë compliquant un traitement par interféron alpha-2a et ribavirine pour hépatite aiguë virale C. ACTA ACUST UNITED AC 2005; 29:616-7. [PMID: 15980766 DOI: 10.1016/s0399-8320(05)82144-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Chisholm JA, Williams G, Spence E, Parks S, Keating D, Gavin M, Mills PR. Retinal toxicity during pegylated alpha-interferon therapy for chronic hepatitis C: a multifocal electroretinogram investigation. Aliment Pharmacol Ther 2005; 21:723-32. [PMID: 15771758 DOI: 10.1111/j.1365-2036.2005.02365.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Ocular side-effects in the form of retinal ischaemia and haemorrhages have been reported in patients undergoing standard alpha-interferon therapy. AIM To assess the ocular impact of therapy with sustained release pegylated alpha-2a interferon (Pegasys) for chronic hepatitis C. METHODS Ten patients receiving Pegasys and ribavirin and 10 healthy volunteers were recruited. Patients underwent full ophthalmic investigations and multifocal electroretinogram testing at baseline, at regular intervals during treatment and post-treatment. The multifocal electroretinogram maps retinal function. Responses were compared with sequential recordings from healthy volunteers. RESULTS All patients had normal clinical ophthalmic investigations at baseline. During therapy a single patient experienced central visual disturbance lasting 24 h with no prolonged ill effect. No other patient was aware of any change in vision. Fundal abnormalities appeared in five patients during treatment. The multifocal electroretinogram showed reductions in retinal function in five patients. Nine of 10 patients exhibited abnormalities on at least one multifocal electroretinogram or fundoscopic investigation. CONCLUSIONS Subclinical retinal toxicity during anti-viral therapy with pegylated alpha-interferon and ribavirin was frequent in this study and it suggests that patients should be warned of this risk and monitored during therapy.
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Affiliation(s)
- J A Chisholm
- Department of Clinical Physics and Bioengineering, Gartnavel General Hospital, Glasgow G12 0YN, UK.
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Cuthbertson FM, Davies M, McKibbin M. Is screening for interferon retinopathy in hepatitis C justified? Br J Ophthalmol 2004; 88:1518-20. [PMID: 15548803 PMCID: PMC1772411 DOI: 10.1136/bjo.2004.043968] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND/AIM In the treatment of hepatitis C, the National Institute for Clinical Excellence advocates use of a combination of interferon alfa and ribavirin for selected patients. Retinopathy is a well recognised side effect of interferon therapy and is characterised by retinal haemorrhages, cotton wool spots, and macular oedema. The aim of this study was to document the incidence and natural history of the retinopathy in patients treated with a long acting (pegylated) interferon and ribavirin for hepatitis C and to assess the need to screen for retinal complications. METHODS All patients started on treatment from September 2002 to August 2003 were invited to participate in the study. The past medical and ocular history, visual symptoms, and the results of a full ophthalmological assessment performed 3 months after starting treatment were noted. Any patient with retinal changes was followed up at 3 month intervals until the changes resolved. RESULTS Of the 25 patients examined, four had evidence of retinopathy including deep retinal haemorrhage and cotton wool spots. Two of the patients were diabetic and one hypertensive. None had any visual symptoms and in all four the retinopathy resolved while the patients completed their course of treatment. CONCLUSIONS The incidence of retinopathy with pegylated interferon is low. The retinal complications resolve while treatment is continued and are asymptomatic. This study does not support routine screening for retinopathy in patients treated with pegylated interferon and ribavirin for hepatitis C.
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Affiliation(s)
- F M Cuthbertson
- St James University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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Kötter I, Günaydin I, Zierhut M, Stübiger N. The use of interferon alpha in Behçet disease: review of the literature. Semin Arthritis Rheum 2004; 33:320-35. [PMID: 15079763 DOI: 10.1016/j.semarthrit.2003.09.010] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of interferon (IFN) alpha for the treatment of Behçet's disease (BD) and discuss its possible mechanisms of action. METHODS Reports published until July 2002 in all languages were identified by the PubMed Database and the BD conference proceedings and abstract booklets. The indexing terms used were "Behçet" and "interferon." RESULTS Thirty-two original reports and 4 selected abstracts were included in the analysis. Systemic IFN-alpha was administered to 338 patients. One hundred eighty-two patients with acute ocular disease were treated with IFN-alpha. Two hundred sixty-four patients received IFN-alpha2a, and 74 received IFN-alpha2b. Eighty-six percent of the patients with mucocutaneous symptoms, 96% with arthritis, and 94% with uveitis exhibited a partial or complete response. Higher IFN doses were more effective than low-dose regimens and led to up to 56% long-term remissions after discontinuation of IFN-alpha were reported. IFN-alpha2a apparently was superior to IFN-alpha2b, with more complete remissions, but this probably was the result of a bias caused by the larger number of patients treated with IFN-alpha2a. Side effects were dose-dependent and similar to those noted in patients with hepatitis C. CONCLUSIONS Although the comparability of the studies is hampered because of different study designs, IFN-alpha is effective for the treatment of BD. It was beneficial even in resistant posterior uveitis, in which long-term remissions with preservation of visual acuity was achieved. In contrast, mostly partial remissions were reported for mucocutaneous symptoms.
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Affiliation(s)
- Ina Kötter
- University Hospital, Department of Internal Medicine II, Tübingen, Germany.
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Farel C, Suzman DL, McLaughlin M, Campbell C, Koratich C, Masur H, Metcalf JA, Robinson MR, Polis MA, Kottilil S. Serious ophthalmic pathology compromising vision in HCV/HIV co-infected patients treated with peginterferon alpha-2b and ribavirin. AIDS 2004; 18:1805-9. [PMID: 15316341 DOI: 10.1097/00002030-200409030-00009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To characterize the ocular changes associated with peginterferon alpha 2b (peg-IFN alpha-2b) and ribavirin therapy for chronic hepatitis C infection in HIV co-infected individuals. METHODS A prospective, open-label trial treating HIV/hepatitis C (HCV) co-infected individuals with peg-IFN alpha-2b and ribavirin at the Warren Grant Magnusson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA. Twenty-three patients with a high mean CD4+ T-cell count were treated with peg-IFN alpha-2b and ribavirin and followed for 40 to 88 weeks. Ophthalmologic evaluations including visual acuity, visual field testing, color vision examination and indirect ophthalmoscopy were performed at baseline and every 3 months. RESULTS Eight of the 23 patients (35%) developed ophthalmologic pathology, including cotton wool spots, cataracts, and two patients developed decreased color vision. These two patients regained their color vision, one after cessation of anti-HCV therapy. CONCLUSIONS Although retinal pathologies have been reported in patients treated with interferon-alpha, they have not been reported during peg-IFN alpha-2b therapy nor in HIV/HCV co-infected patients. The incidence of serious ocular pathology associated with anti-HCV therapy may be very high and is probably associated with peg-IFN alpha-2b. Increased monitoring of patients treated with peg-IFN alpha-2b for retinal and visual changes is warranted.
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Affiliation(s)
- Claire Farel
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Abstract
Ocular toxicity, including retinopathy, optic neuropathy and ocular loss, has been infrequently (<1%) reported as a potentially serious adverse event associated with standard interferon therapy. The new pegylated interferons have improved pharmacokinetics which translates to better antiviral efficacy, however, this improved pharmacokinetic profile also has the potential to alter the frequency and extent of their adverse events. We describe a case of chronic hepatitis C infection that developed visual complaints after one month of pegylated interferon, and retinopathy confirmed on ophthalmologic examination. We place our report in context with a review of the literature related to visual complications associated with interferon therapy. From our compilation of case reports, it is apparent that variable doses and duration of interferon therapy have been associated with ocular toxicity, which in turn suggests an idiosyncratic drug reaction. In as much as this adverse event is unpredictable, and its frequency undefined with pegylated interferon therapy, further surveillance will be required for patients undergoing pegylated-interferon therapy. Although ocular toxicity is uncommon, it should be emphasized that it can occur any time after the start of interferon therapy, and physicians now treating chronic hepatitis C patients with pegylated interferon must be aware of this potentially serious adverse event.
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Crochet M, Ingster-Moati I, Even G, Dupuy P. Rétinopathie à l’interféron-α associé à la ribavirine : atteinte de l’électro-oculogramme. J Fr Ophtalmol 2004; 27:257-62. [PMID: 15039627 DOI: 10.1016/s0181-5512(04)96127-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Ophthalmological complications with interferon alpha (INF-alpha) have been described since 1992: toxic retinopathy with cotton-wool spots, retinal hemorrhages, visual evoked potential (VEP) modifications and visual field abnormalities. MATERIAL AND METHOD In 2002, a 44-year-old woman was referred complaining of visual problems. In 1986, she had been diagnosed with chronic hepatitis C and underwent INF-alpha therapy for 6 months with no ophthalmological symptoms. In 2001, she began a second course of INF-alpha therapy along with ribavirin. After 5 months, in February 2002, she developed hypothyroidism induced by INF, received levothyroxine and her treatment for the hepatitis C was stopped. One month later, in March, she complained of visual difficulties in dim light. Clinical ophthalmological examination and Goldmann visual field testing, electroretinogram (ERG) and visual evoked potentials (VEP) were normal but the electro-oculogram (EOG) showed that the light-peak-to-dark-trough ratios were very low: 148% in the right eye, 156% in the left eye. The fluorescein angiography was normal. The patient was followed up 4 months later, in June 2002 (after 5 months without INF-alpha therapy), showing a slight improvement of the EOG and no visual symptoms. Two other follow-up examinations were done in September 2002 and January 2003: the slight improvement persisted but the EOGs remain below the normal range values. DISCUSSION AND CONCLUSION A review of the literature brought out that an EOG is not usually done in the monitoring of patients taking INF-alpha, but we decided to do this examination because of her symptoms, the first case to our knowledge in a patient taking INF-alpha. This case report underlines the necessity of an EOG on patients with INF-alpha therapy. Until now, the pathogenesis of this retinal toxicity has been poorly understood. These results show that the retinal pigmented epithelium is probably implicated at an early stage in this retinal toxicity.
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Schulman JA, Liang C, Kooragayala LM, King J. Posterior segment complications in patients with hepatitis C treated with interferon and ribavirin. Ophthalmology 2003; 110:437-42. [PMID: 12578794 DOI: 10.1016/s0161-6420(02)01741-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To determine the incidence and type of posterior segment complications associated with the use of interferon alpha 2b and ribavirin in patients with chronic hepatitis C. DESIGN A prospective noncomparative case series. PARTICIPANTS Forty-two patients (84 eyes). METHODS Patients with chronic hepatitis C were evaluated for ocular changes while being treated with interferon alpha 2b and ribavirin. Patients were followed with sequential ocular examinations for 4 to 20 months. MAIN OUTCOME MEASURES Occurrence of posterior segment complications while on interferon and ribavirin therapy. RESULTS Twenty-seven patients developed retinopathy. The retinopathy consisted of single-to-multiple cotton-wool spots and retinal hemorrhage and was transient in all cases. An additional patient (age 46) presented with asymptomatic disc edema and hemorrhage. One other individual developed a symptomatic permanent monocular visual field defect. Therapy was discontinued in three patients because of severe posterior segment pathology. CONCLUSIONS Our study demonstrated that a high incidence of retinopathy is associated with the treatment of hepatitis C using interferon and ribavirin, but that this form of retinopathy is relatively benign. Regular ophthalmic monitoring should be performed in patients undergoing this treatment.
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Affiliation(s)
- Joel A Schulman
- Department of Ophthalmology, Louisiana State University Health Science Center, 1501 Kings Highway, Shreveport, LA 71130, USA
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Perlemuter G, Bodaghi B, Le Hoang P, Izem C, Buffet C, Wechsler B, Piette JC, Cacoub P. Visual loss during interferon-alpha therapy in hepatitis C virus infection. J Hepatol 2002; 37:701-2. [PMID: 12399242 DOI: 10.1016/s0168-8278(02)00243-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Collier J, Chapman R. Combination therapy with interferon-alpha and ribavirin for hepatitis C: practical treatment issues. BioDrugs 2001; 15:225-38. [PMID: 11437688 DOI: 10.2165/00063030-200115040-00003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Combination therapy with ribavirin and interferon (IFN)-alpha for 6 to 12 months is currently the treatment of choice for chronic hepatitis C infection. The overall sustained response rate to treatment, defined as loss of hepatitis C virus (HCV) from serum 6 months after completion of treatment, is 40%. The indications for treatment are serum HCV RNA positivity, abnormal serum transaminases and the presence of portal fibrosis and/or moderate/severe inflammation. Response rates are lower in genotype 1 than in genotype 2 or 3 and in the presence of a high viral load. Anaemia is the most common adverse event and is due to ribavirin; neuropsychiatric adverse effects due to IFNalpha lead to premature cessation of therapy in 10 to 20% of patients. The current recommended dose of interferon is 3MU given subcutaneously 3 times a week. However, it is likely that longer-acting pegylated interferons, which may be more effective and can be administered once weekly, will in the future replace currently used IFNalpha.
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Affiliation(s)
- J Collier
- Department of Gastroenterology, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, England.
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Esmaeli B, Koller C, Papadopoulos N, Romaguera J. Interferon-induced retinopathy in asymptomatic cancer patients. Ophthalmology 2001; 108:858-60. [PMID: 11320013 DOI: 10.1016/s0161-6420(01)00546-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Interferon-induced ocular complications, including retinal ischemia and ischemic optic neuropathy, can be associated with significant visual loss. We report three cases of asymptomatic ischemic retinopathy in cancer patients receiving interferon. DESIGN Retrospective, interventional, noncomparative small case series. METHODS Retrospective review of the medical records and fundus photographs. RESULTS Interferon-induced ischemic retinopathy can occur in asymptomatic cancer patients. The retinal changes are usually reversible with discontinuation of interferon therapy. CONCLUSIONS These three cases underscore the importance of dilated funduscopic examination at baseline and during follow-up, at least every 3 months, for all cancer patients receiving interferon to identify retinal toxicity at its earliest stages. A prospective study evaluating the incidence and severity of interferon retinopathy in cancer patients would be prudent.
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Affiliation(s)
- B Esmaeli
- Ophthalmology Section, Department of Plastic Surgery, University of Texas, M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas, USA
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Isler M, Akhan G, Bardak Y, Akkaya A. Dry cough and optic neuritis: two rare complications of interferon alpha treatment in chronic viral hepatitis. Am J Gastroenterol 2001; 96:1303-4. [PMID: 11316196 DOI: 10.1111/j.1572-0241.2001.03727.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ogundipe O, Smith M. Bell's palsy during interferon therapy for chronic hepatitis C infection in patients with haemorrhagic disorders. Haemophilia 2000; 6:110-2. [PMID: 10781198 DOI: 10.1046/j.1365-2516.2000.00391.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two adult patients with life-long severe haemorrhagic disorders commenced on interferon-alpha2b therapy for chronic hepatitis C infection. Both developed Bell's palsy several weeks after commencing therapy, They were started on steroids and, in addition, the first patient discontinued interferon-alpha2b therapy while the second patient elected to continue with therapy. In both cases facial paralysis improved over the ensuing weeks. Bell's palsy is often idiopathic but has been reported. in association with herpesviruses. It is not a recognised complication of chronic hepatitis B or C infection, or interferon-alpha2b therapy. However, the interferons are associated with numerous adverse reactions including various neuropsychiatric manifestations and neurological syndromes. There are several reports of nerve palsies, including optic tract neuropathy, occurring during interferon therapy, and immune-based mechanisms are thought to play a role in the aetiopathogenesis. No reports of Bell's palsy in association with interferon therapy were identified in our literature search, although one possible case has been reported to the Committee of Safety in Medicine. Although Bell's palsy in our patients may have occurred by chance, a neuropathic effect of interferon-alpha2b on the facial nerve cannot be excluded and we urge physicians using interferons to be aware of this potential side-effect.
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Affiliation(s)
- O Ogundipe
- Supraregional Haemophilia Centre, St Thomas' Hospital, London, UK
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Vial T, Choquet-Kastylevsky G, Liautard C, Descotes J. Endocrine and neurological adverse effects of the therapeutic interferons. Toxicology 2000; 142:161-72. [PMID: 10667887 DOI: 10.1016/s0300-483x(99)00141-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There is experimental evidence that the nervous central and the neuroendocrine systems can influence the immune system, which can in turn influence the brain activity. Endogenous cytokines are known to play a critical role in the pathophysiology of many diseases. The recently acquired experience on the adverse effects of therapeutic cytokines, particularly neurological and endocrine adverse effects, are further illustrative of these interferences. Interferons-alpha have been used in thousands of patients, so that the information accumulated with this group of closely related products is essential to delineate the potential and severity for non-immunological, but largely immune-mediated adverse effects to develop in patients treated with immuno-activating agents.
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Affiliation(s)
- T Vial
- Lyon Poison Centre and Pharmacovigilance Unit, Hôpital Edouard Herriot, France.
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THERAPEUTIC VACCINES FOR CHRONIC HEPATITIS B INFECTION. Sex Transm Dis 2000. [DOI: 10.1016/b978-012663330-6/50015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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35
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Affiliation(s)
- S I Mellgren
- Department of Neurology, Medical Faculty, University of Tromsö, Norway.
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Dumoulin FL, Leifeld L, Sauerbruch T, Spengler U. Autoimmunity induced by interferon-alpha therapy for chronic viral hepatitis. Biomed Pharmacother 1999; 53:242-54. [PMID: 10424246 DOI: 10.1016/s0753-3322(99)80095-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Type I interferons, which are mostly alpha-interferons (either as single agents or in combination with antiviral drugs), are currently the standard therapy for chronic viral hepatitis B, B/D, and C. Side-effects are not uncommon and include exacerbation of pre-existing autoimmune disorders or the de novo induction of autoimmunity. These adverse effects are attributed to the immunomodulatory properties of type I interferons, and should be distinguished from autoimmunity associated with chronic viral hepatitis in which interferon treatment may indeed be beneficial. The major autoimmune side-effects of interferon therapy for chronic viral hepatitis are thyroid or liver disease. Therefore, screening for thyroid antibodies and auto-antibodies indicative of autoimmune hepatitis both before, during, and after interferon therapy is strongly recommended. The presence of high concentrations of thyroid auto-antibodies or antibodies associated with autoimmune hepatitis can be contraindicative to interferon therapy. However, treatment is not contraindicated in viral hepatitis (in particular chronic hepatitis C) associated with autoimmune phenomena--including low-titer thyroid antibodies or other non-organ specific auto-antibodies. If interferon-induced autoimmunity occurs, the necessity of therapy has to be balanced carefully against the risks of autoimmune disease. Further research is needed to identify the factors which determine susceptibility to interferon-associated autoimmunity in individual patients.
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Affiliation(s)
- F L Dumoulin
- Medizinische Klinik und Poliklinik I, Universität Bonn, Germany
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Abstract
Viral hepatitis is still one of the most common causes of acute and chronic liver disease worldwide. Major advances have been made in our knowledge of these diseases, many during the past year. Molecular biology and clinical studies have improved our understanding of the mechanisms of antiviral drugs, as well as viral resistance to therapy. The risks of hepatitis A in patients with chronic liver disease have been confirmed, and the efficacy of hepatitis A vaccines in these patients has been proven. Aggressive combination therapy has emerged as a promising strategy for chronic hepatitis B and C, and techniques for immune prophylaxis for hepatitis B are being improved. Liver transplantation has become routine for end-stage hepatitis B virus liver disease, and new strategies to prevent and treat recurrence are being explored. This review discusses the recent advances in our knowledge of hepatitis viruses A through G, focusing on the literature of the past year.
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Affiliation(s)
- A Regev
- Center for Liver Diseases, Miami, Florida, USA
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