1
|
Abstract
Cytokines, currently known to be more than 130 in number, are small MW (<30 kDa) key signaling proteins that modulate cellular activities in immunity, infection, inflammation and malignancy. Key to understanding their function is recognition of their pleiotropism and often overlapping and functional redundancies. Classified here into 9 main families, most of the 20 approved cytokine preparations (18 different cytokines; 3 pegylated), all in recombinant human (rh) form, are grouped in the hematopoietic growth factor, interferon, platelet-derived growth factor (PDGF) and transforming growth factor β (TGFβ) families. In the hematopoietin family, approved cytokines are aldesleukin (rhIL-2), oprelvekin (rhIL-11), filgrastim and tbo-filgrastim (rhG-CSF), sargramostim (rhGM-CSF), metreleptin (rh-leptin) and the rh-erythropoietins, epoetin and darbepoietin alfa. Anakinra, a recombinant receptor antagonist for IL-1, is in the IL-1 family; recombinant interferons alfa-1, alfa-2, beta-1 and gamma-1 make up the interferon family; palifermin (rhKGF) and becaplermin (rhPDGF) are in the PDGF family; and rhBMP-2 and rhBMP-7 represent the TGFβ family. The main physicochemical features, FDA-approved indications, modes of action and side effects of these approved cytokines are presented. Underlying each adverse events profile is their pleiotropism, potency and capacity to release other cytokines producing cytokine 'cocktails'. Side effects, some serious, occur despite cytokines being endogenous proteins, and this therefore demands caution in attempts to introduce individual members into the clinic. This caution is reflected in the relatively small number of cytokines currently approved by regulatory agencies and by the fact that 14 of the FDA-approved preparations carry warnings, with 10 being black box warnings.
Collapse
|
2
|
Pugi A, Bonaiuti R, Maggini V, Moschini M, Tuccori M, Leone R, Rossi M, Motola D, Piccinni C, Ferrazin F, Sottosanti L, Mugelli A, Vannacci A, Lapi F. Safety profile of antiviral medications: A pharmacovigilance study using the Italian spontaneous-reporting database. Am J Health Syst Pharm 2013; 70:1039-46. [DOI: 10.2146/ajhp120665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Alessandra Pugi
- Department of Neuroscience, Psychology, Drug Research and Child Health, Interuniversity Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, and Pharmacovigilance Center of Tuscan County (PCTC), Florence, Italy
| | - Roberto Bonaiuti
- Department of Neuroscience, Psychology, Drug Research and Child Health, Interuniversity Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, and Pharmacovigilance Center of Tuscan County (PCTC), Florence, Italy
| | - Valentina Maggini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Interuniversity Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, and Pharmacovigilance Center of Tuscan County (PCTC), Florence, Italy
| | - Martina Moschini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Interuniversity Center of Molecular Medicine and Applied Biophysics (CIMMBA), University of Florence, and Pharmacovigilance Center of Tuscan County (PCTC), Florence, Italy
| | - Marco Tuccori
- PCTC, and Interdepartmental Center for Research in Clinical Pharmacology and Experimental Therapeutics, University of Pisa, Pisa, Italy
| | - Roberto Leone
- Clinical Pharmacology Unit, University of Verona, Verona, Italy
| | - Marco Rossi
- PCTC, and University Hospital of Siena, Siena, Italy
| | - Domenico Motola
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Piccinni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fernanda Ferrazin
- National Pharmacovigilance Office, Pharmacovigilance Unit, Italian Medicines Agency, Rome
| | - Laura Sottosanti
- National Pharmacovigilance Office, Pharmacovigilance Unit, Italian Medicines Agency, Rome
| | - Alessandro Mugelli
- Department of Neuroscience, Psychology, Drug Research and Child Health, CIMMBA, and PCTC
| | - Alfredo Vannacci
- Department of Neuroscience, Psychology, Drug Research and Child Health, CIMMBA, and PCTC
| | - Francesco Lapi
- Department of Neuroscience, Psychology, Drug Research and Child Health, CIMMBA, PCTC, and the Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Tran HA, Jones TL, Ianna EA, Foy A, Reeves GEM. Thyroid disease in chronic hepatitis C infection treated with combination interferon-α and ribavirin: management strategies and future perspective. Endocr Pract 2013; 19:292-300. [PMID: 23186968 PMCID: PMC4134094 DOI: 10.4158/ep12195.ra] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hepatitis C virus (HCV) infection is one of the major epidemics afflicting young people in both developed and developing countries. The most common endocrine disorder associated with this infection, especially in conjunction with interferon-α (IFN-α)-based therapy, is thyroid disease (TD). This review examines the development of TD before, during, and after the completion of treatment with combination IFN-α and ribavirin (RBV) for chronic HCV infection. We also summarize the current understanding of the natural history of the condition and propose management and follow-up guidelines. METHODS PubMed was searched up to June 30, 2011 for English-language publications that contained the search terms "hepatitis C virus," "chronic hepatitis C," "HCV," "thyroid disease," "thyroiditis," "autoimmunity," "interferon-alpha," and "ribavirin." Additional publications were identified from the reference lists of identified papers. The included studies were original research publications and included combination IFN-α and RBV use in patients that developed TD. RESULTS The prevalence of TD before combination IFN-α and RBV therapy ranges from 4.6 to 21.3%; during therapy, 1.1 to 21.3%; and after therapy, 6.7 to 21.3%. The most common TD is thyroiditis. Thyroid function testing (TFT) frequency and diagnostic criteria for various thyroid conditions are not standardized, and many of the existing studies are retrospective. CONCLUSION Patients undergoing this therapy should be assessed with a standardized protocol to appropriately detect and manage developed TD. Based on the currently available literature, we recommend that patients receiving combination interferon-α and RBV therapy undergo monthly thyrotropin (TSH) level testing.
Collapse
Affiliation(s)
- Huy A Tran
- Department of Clinical Chemistry, Hunter Area Pathology Service, Newcastle, New South Wales, Australia.
| | | | | | | | | |
Collapse
|
4
|
Nair Kesavachandran C, Haamann F, Nienhaus A. Frequency of thyroid dysfunctions during interferon alpha treatment of single and combination therapy in hepatitis C virus-infected patients: a systematic review based analysis. PLoS One 2013; 8:e55364. [PMID: 23383326 PMCID: PMC3562313 DOI: 10.1371/journal.pone.0055364] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/21/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Thyroid dysfunction is the commonest endocrinopathy associated with HCV infection due to interferon-based treatment. This comprehensive and systematic review presents the available evidence for newly developed thyroid antibodies and dysfunctions during interferon treatment (both single and combination) in HCV patients. METHODOLOGY/PRINCIPAL FINDINGS This systematic review was conducted in accordance with the PRISMA guidelines. The data generated were used to analyze the risk for thyroid dysfunctions during interferon (IFN) treatment in HCV patients. There was a wide range in the incidence of newly developed thyroid dysfunctions and thyroid antibodies in HCV patients during IFN treatment (both single and combination). The wide range of incidence also denoted the possibility of factors other than IFN treatment for thyroid-related abnormalities in HCV patients. These other factors include HCV viral factors, genetic predisposition, environmental factors, and patho-physiological factors. Variations in IFN dosage, treatment duration of IFN, definition/criteria followed in each study for thyroid dysfunction and irregular thyroid function testing during treatment in different studies influence the outcome of the single studies and jeopardise the validity of a pooled risk estimate of side effects of thyroid dysfunction. Importantly, reports differ as to whether the thyroid-related side effects disappear totally after withdrawal of the IFN treatment. CONCLUSIONS/SIGNIFICANCE The present review shows that there is a wide range in the incidence of newly developed thyroid dysfunctions and thyroid antibodies in IFN treated HCV patients. This is a comprehensive attempt to collate relevant data from 56 publications across several nations about IFN (both mono and combination therapy) related thyroid dysfunction among HCV patients. The role of each factor in causing thyroid dysfunctions in HCV patients treated with IFN should be analyzed in detail in future studies, for a better understanding of the problem and sounder clinical management of the disease.
Collapse
Affiliation(s)
- Chandrasekharan Nair Kesavachandran
- Centre for Epidemiology and Health Services Research in the Nursing Profession-CV Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | | | | |
Collapse
|
5
|
Yan Z, Fan K, Fan Y, Wang X, Mao Q, Deng G, Wang Y. Thyroid dysfunction in chinese patients with chronic hepatitis C treated with interferon alpha: incidence, long-term outcome and predictive factors. HEPATITIS MONTHLY 2012; 12:e6390. [PMID: 23087763 PMCID: PMC3475135 DOI: 10.5812/hepatmon.6390] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/13/2012] [Accepted: 06/30/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Thyroid dysfunction (TD) represents an extra-hepatic manifestation of chronic hepatitis C (CHC) and it may also be a side effect of interferon-alpha (IFN-α) based treatment. However, previous studies have shown a wide variation in the incidence of TD in patients with CHC. Furthermore, the long-term outcomes and the predictive factors of TD in patients who receive IFN-α based treatment have still not been fully studied. OBJECTIVES The purpose of this study was to describe the incidence and long-term outcomes of TD in Chinese patients with CHC receiving IFN-αbased treatment. We also aimed to identify the predictive factors of TD associated with this type of therapy. PATIENTS AND METHODS A retrospective case-series study of 592 consecutive CHC patients with normal baseline thyroid functions, who received IFN-αbased therapy, was performed. Thyroid function was assessed at baseline and every three months during treatment, as well as in the follow-up after cessation of therapy. The incidence and long-term outcomes of TD were observed. The prevalence of pretreatment thyroid peroxidase antibodies (TPOAb) were assayed in a sex- and age-matched nested case-control study. Multivariable stepwise regression analysis was used to explore the independent effects of the baseline factors, on the incidence of TD. RESULTS At the end of the IFN-αbased therapy, 68 patients (11.5%) in the study had developed TD, 58 patients (85.3%) presented with subclinical TD, and only 10 patients (14.7%) developed overt thyroiditis. The thyroid function of 46 patients (67.8%) spontaneously returned to normal in the six months of follow-up and only three patients (4.4%) had persistent overt TD symptoms after the 24 month follow-up period. Multivariate stepwise analysis suggested that gender and pretreatment TPOAb were the independent factors related to the incidence of TD. Both female patients (OR, 4.31; 95%CI, 2.06-7.31; P = 1.26×10-4) and participants with a positive pretreatment TPOAb (OR = 3.9, 95%CI, 1.72-8.54, P = 0.008) had an increased risk for the development of TD. CONCLUSIONS The incidence of TD in Chinese patients with CHC during IFN-αbased therapy was 11.5%, the majority of which was subclinical, while only a very small group had long-term overt TD requiring ongoing medical therapy. Female gender and pretreatment TPOAb positivity are risk factors for the development of TD during IFN-αbased therapy.
Collapse
Affiliation(s)
- Zehui Yan
- Institute of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Ke Fan
- Institute of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Yi Fan
- Institute of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Xiaohong Wang
- Institute of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Qing Mao
- Institute of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Guohong Deng
- Institute of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
| | - Yuming Wang
- Institute of Infectious Diseases, Southwest Hospital, the Third Military Medical University, Chongqing, China
- Corresponding author: Yuming Wang, Institute of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China. Tel.: +86-2368754858, Fax: +86-2365334998, E-mail:
| |
Collapse
|
6
|
Association of interferon-alpha and ribavirin-induced thyroid dysfunction with severity of disease and response to treatment in pakistani asian patients of chronic hepatitis C. HEPATITIS RESEARCH AND TREATMENT 2012; 2012:864315. [PMID: 22973506 PMCID: PMC3438721 DOI: 10.1155/2012/864315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/11/2012] [Accepted: 07/19/2012] [Indexed: 11/17/2022]
Abstract
Objective. To determine the association of thyroid dysfunction with the severity of the disease and response to treatment in patients of chronic hepatitis C. Design. Cohort study. Patients. One hundred and sixty seven noncirrhotic chronic hepatitis C patients were grouped into treatment group (n = 107) and control group (n = 60). Measurements. Baseline S. ALT and S. AST by IFCC and S. TSH, S. free T4, and S.T3 level were measured by chemiluminescence method. The severity of the disease was measured by Knodell histopathological index (HPI) on liver biopsy. Study group patients underwent 24-weeks IFN and ribavirin therapy and thyroid functions were determined at weeks 0, 12, and 24. Response to therapy was determined by PCR-HCV test. Results. 20 treated patients (18.69%) developed thyroid dysfunction with relative risk (RR) of 11.25 and attributable risk (AR) of 91%. Females were at higher risk. Hypothyroidism was common than hyperthyroidism. There was no significant association between thyroid dysfunction and severity of the disease (P = 0.81) and response to therapy (P = 0.79). Conclusion. Interferon-alpha and ribavirin therapy induces thyroid dysfunction in chronic hepatitis C patients. There is no association between severity of disease and response to therapy with interferon-induced thyroid dysfunction.
Collapse
|
7
|
Thyroid dysfunction in Turkish patients with chronic hepatitis C receiving peginterferon plus ribavirin in the period of 2005-2010. Braz J Infect Dis 2012; 16:448-51. [PMID: 22964290 DOI: 10.1016/j.bjid.2012.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/02/2012] [Indexed: 01/02/2023] Open
Abstract
Interferon-α based therapy for chronic hepatitis C (CHC) is associated with thyroiditis and thyroid dysfunction (TD). This study investigated whether TD during pegylated interferon-α (PEG-IFN) plus ribavirin treatment favors sustained viral response (SVR), and also the association between TD and PEG-IFN formulations. This retrospective study was performed in CHC patients who had received PEG-IFN plus ribavirin and had been followed for six months after treatment. Several factors were compared between patients with and without TD. 119 patients were included in the study. De novo incidence of TD was found to be 16.8%, and 16 of the 18 patients with TD achieved SVR. Although this rate was higher than patients without TD according to univariate analysis, logistic regression analysis revealed that there was not a significant association between TD and SVR, whereas baseline thyroperoxidase antibody (anti-TPO) positivity was the only significant predictor of TD. Moreover, TD was not associated with PEG-IFN type. Both interferon-α and hepatitis C virus (HCV) contribute to TD during antiviral therapy. It seems that there is no association between thyroid toxicity and viral clearance or type of PEG-IFN; however, anti-TPO positivity before treatment is the strongest predictor for TD during antiviral therapy.
Collapse
|
8
|
Tran HA, Jones TL, Ianna EA, Gibson RA, Reeves GEM. The reduced predictive value of interleukin 28b gene polymorphisms in a cohort of patients with thyroiditis developed during antiviral therapy for chronic hepatitis C: a preliminary study. HEPATITIS MONTHLY 2012; 12:e6036. [PMID: 23087747 PMCID: PMC3475014 DOI: 10.5812/hepatmon.6036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/15/2012] [Accepted: 05/22/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Single nucleotide polymorphism in the interleukin28B (IL28B) gene was recently shown to be associated with a significant increase in response to interferon-α and ribavirin treatment in patients with chronic hepatitis C. Similarly, thyroid disease (TD) occurring during treatment confer an improved sustained virologic response (SVR). OBJECTIVES To determine the role of IL28B genotypes in a cohort of hepatitis C patients who develop TD during treatment and its relationship to SVR. PATIENTS AND METHODS IL28B gene profiles including rs12979860, rs12980275 and rs 8099917 and their genotypes were determined in a cohort of 23 hepatitis C patients who developed TD during treatment and their relationship to SVR. RESULTS Out of 23 studies cases, 19 has one or more favorable genotypes, of which 15 (78.9%) achieved SVR. Eleven has all three unfavorable genotypes and yet achieved 72.7 % SVR. The presence of more than one favorable genotype only correctly predicts SVR vs. non- SVR in ~50 % of cases, i.e. by chance. CONCLUSIONS Despite the small number of subjects, the presence of one or more unfavorable IL28B genotype does not portend a poor SVR prognostic outcome. This suggests that TD in this clinical context may be a critical factor in the achievement of SVR, probably above that of the genetic predisposition.
Collapse
Affiliation(s)
- Huy A Tran
- Hunter Area Pathology Service, John Hunter Hospital, Newcastle, Australia
- Corresponding author: Huy A Tran, Pathology Service, John Hunter Hospital, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia. Tel.: +61-249214005, Fax: +61-249214440, E-mail:
| | - Tracey L Jones
- Hepatitis C Service, Gastroenterology Department, John Hunter Hospital, Newcastle, Australia
| | - Elizabeth A Ianna
- Hepatitis C Service, Gastroenterology Department, John Hunter Hospital, Newcastle, Australia
| | - Robert A Gibson
- Hepatitis C Service, Gastroenterology Department, John Hunter Hospital, Newcastle, Australia
| | - Glenn E M Reeves
- Hunter Area Pathology Service, John Hunter Hospital, Newcastle, Australia
| |
Collapse
|
9
|
Tran HA, Jones TL, Gibson R, Reeves GEM. Thyroid disease is a favorable prognostic factor in achieving sustained virologic response in chronic hepatitis C undergoing combination therapy: A nested case control study. BMC Endocr Disord 2011; 11:10. [PMID: 21605462 PMCID: PMC3123561 DOI: 10.1186/1472-6823-11-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 05/24/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Interferon-α in combination with ribavirin is the current gold standard for treatment of chronic hepatitis C. It is unknown if the development of autoimmune thyroid disease (TD) during treatment confers an improved chance of achieving sustained virologic response. The aim of this study is to assess the chance of achieving sustained virologic response (SVR) in patients who developed TD during treatment when compared with those who did not. METHODS We performed a tertiary hospital-based retrospective nested case-control analysis of 19 patients treated for hepatitis C who developed thyroid disease, and 76 controls (matched for age, weight, gender, cirrhosis and aminotransferase levels) who did not develop TD during treatment. Multivariate logistic-regression models were used to compare cases and controls. RESULTS The development of TD was associated with a high likelihood of achieving SVR (odds ratio, 6.0; 95% confidence interval, 1.5 to 24.6) for the pooled group containing all genotypes. The likelihood of achieving SVR was increased in individuals with genotype 1 HCV infection who developed TD (odds ratio, 5.2; 95% confidence interval, 1.2 to 22.3), and all genotype 3 patients who developed TD achieved SVR. CONCLUSIONS Development of TD during treatment for hepatitis C infection is associated with a significantly increased chance of achieving SVR. The pathophysiogical mechanisms for this observation remain to be determined. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRB12610000830099.
Collapse
Affiliation(s)
- Huy A Tran
- Hunter Area Pathology Service and University of Newcastle, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia
| | - Tracey L Jones
- Hepatitis C Service, Gastroenterology Department, John Hunter Hospital and University of Newcastle, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia
| | - Robert Gibson
- Hepatitis C Service, Gastroenterology Department, John Hunter Hospital and University of Newcastle, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia
| | - Glenn EM Reeves
- Hunter Area Pathology Service and University of Newcastle, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia
| |
Collapse
|
10
|
Tran HA, Jones TL, Ianna EA, Reeves GE. The natural history of interferon-α induced thyroiditis in chronic hepatitis c patients: a long term study. Thyroid Res 2011; 4:2. [PMID: 21214950 PMCID: PMC3022887 DOI: 10.1186/1756-6614-4-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 01/08/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Autoimmune thyroid disease is a common complication of patients with chronic hepatitis C undergoing combination pegylated interferon-α and ribavirin treatment. A small proportion develops interferon-induced thyroiditis of which the long term natural history is unknown and how it compares with de novo thyroiditis. The aim of the study is to determine the natural history of thyroid disease including antibody profile in this particular setting 36 months from the completion of therapy. METHODS A cohort of 18 hepatitis C patients (mean age 45 ± 8 years (standard deviation)) who developed exclusively thyroiditis in this setting was followed every 12 months after the completion of therapy for 36 months. Investigations included thyrotropin, free tetra-iodothyronine, free tri-iodothyronine levels and thyroid autoantibodies. RESULTS None of the patients developed any long term thyroid disease. Two patients had a prolonged hypothyroid phase of the thyroiditis early after the completion of treatment but recovered fully. The remaining 16 patients remained euthyroid. Similarly, thyroid autoantibodies all declined and returned to reference range. CONCLUSIONS The long term natural history in this small series of interferon induced thyroiditis was benign. If a larger series confirms a similar outcome then there is no long term residual effect on thyroid function and follow-up testing would not be warranted.
Collapse
Affiliation(s)
- Huy A Tran
- Hunter Area Pathology Service and University of Newcastle, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia
| | - Tracey L Jones
- Hepatitis C Service, Gastroenterology Department, John Hunter Hospital and University of Newcastle, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia
| | - Elizabeth A Ianna
- Hepatitis C Service, Gastroenterology Department, John Hunter Hospital, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia
| | - Glenn Em Reeves
- Hunter Area Pathology Service and University of Newcastle, Locked Bag Number 1, Hunter Mail Region Centre, Newcastle, New South Wales 2310, Australia
| |
Collapse
|
11
|
Tran HA, Reeves GEM, Lyons TJ, Attia JR. Histopathologic findings of autoimmunity in thyroid, pituitary, and adrenal diseases in chronic hepatitis C postmortem cases. Endocr Pract 2010; 16:566-9. [PMID: 20150020 DOI: 10.4158/ep09359.or] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the histologic prevalence of immune-mediated thyroid, pituitary, and adrenal diseases in postmortem cases with hepatitis C. METHODS We reviewed 108 consecutive cases of chronic hepatitis C in patients in whom a complete postmortem examination was performed. All microscopic and histologic slides of the thyroid, pituitary, and adrenal reports were reviewed and assessed for evidence of autoimmune diseases. These were compared with a control group of 100 postmortem cases without hepatitis C. RESULTS In chronic hepatitis C infection, there is a heightened immune response resulting in many autoimmune diseases. The commonest endocrinopathy in association with this chronic infection is thyroid disease, a finding confirmed in our current study. Among the 108 postmortem cases of hepatitis C, there were 14 cases (13%) with evidence of thyroiditis. No cases of pituitary or adrenal disease were found. The mean age of the patients was 52 years (range, 29 to 68). This frequency compared with 7 cases of thyroid disease (7%) in the control group (no significant difference between the 2 groups). CONCLUSION On the basis of our postmortem data, thyroid disease was the only major endocrinopathy associated with hepatitis C infection, with a prevalence of 13%. This was comparable with other serologic and nonhistologic antemortem findings. There was no evidence of pituitary or adrenal involvement.
Collapse
Affiliation(s)
- Huy A Tran
- Hunter Area Pathology Service, Hunter Mail Region Centre, Newcastle, New South Wales, Australia.
| | | | | | | |
Collapse
|
12
|
Tran HA, Malcolm Reeves GE, Gibson R, Attia JR. Development of thyroid diseases in the treatment of chronic hepatitis C with alpha-interferon may be a good prognosticator in achieving a sustained virological response: a meta-analysis. J Gastroenterol Hepatol 2009; 24:1163-8. [PMID: 19682190 DOI: 10.1111/j.1440-1746.2009.05874.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Thyroid dysfunction is the most common endocrinopathy associated with hepatitis C and its interferon-based treatment. When undergoing treatment, interferon and ribavirin synergize to potently stimulate the immune system in order to eradicate the virus. One of the innocent bystanders in this accentuated response is the thyroid. The present study investigated whether thyroid dysfunction while undergoing combination treatment for hepatitis C is a favorable prognostic maker for a sustained virological response. METHODS We carried out a prospective clinical audit in 201 patients treated with combination ribavirin and alpha-interferon and determined the prevalence of sustained virological response in patients in association with thyroid disease. A meta-analysis was also carried out pooling 741 patients from four previous studies on this topic. RESULTS There was positive and significant association between thyroid disease and viral clearance. This was not supported by the meta-analysis, however, and some plausible explanations are proffered for this inconsistency. CONCLUSION Despite lacking supportive evidence from the meta-analysis, it is important that this information is confirmed (or refuted) in future studies.
Collapse
Affiliation(s)
- Huy Anh Tran
- Hunter Area Pathology Service, John Hunter Hospital, University of Newcastle, New South Wales, Australia.
| | | | | | | |
Collapse
|
13
|
Tran HA, Reeves GEM. The Spectrum of Autoimmune Thyroid Disease in the Short to Medium Term Following Interferon-alpha Therapy for Chronic Hepatitis C. Int J Endocrinol 2009; 2009:241786. [PMID: 19946425 PMCID: PMC2778562 DOI: 10.1155/2009/241786] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Revised: 06/09/2009] [Accepted: 07/15/2009] [Indexed: 11/17/2022] Open
Abstract
Autoimmune thyroid diseases are common manifestations of hepatitis C infection, exacerbated by interferon-based treatment. However, the occurrence and pattern of thyroid disease in the short/medium term following the completion of IFN-based therapy is relatively unknown and there are very few previous reports regarding the specific spectrum of autoimmune thyroid disease that may follow such therapy. We hereby report 3 cases which demonstrate the range of thyroid diseases that may occur following interferon therapy. The hypothesis advanced is that in the pathogenesis of these conditions there must be both triggering and sustaining mechanisms as thyroid diseases occur well outside the immediate effect window of pegylated interferon. This paper suggests the need to continue thyroid surveillance in IFN-treated HCV patients following the completion of therapy, perhaps for the first 6 months.
Collapse
Affiliation(s)
- Huy A. Tran
- Hunter Area Pathology Service, Hunter Mail Region Centre, John Hunter Hospital, Locked Bag Number 1, Newcastle, NSW 2310, Australia
- *Huy A. Tran:
| | - Glenn E. M. Reeves
- Hunter Area Pathology Service, Hunter Mail Region Centre, John Hunter Hospital, Locked Bag Number 1, Newcastle, NSW 2310, Australia
| |
Collapse
|