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Ribavirin. MEYLER'S SIDE EFFECTS OF DRUGS 2016. [PMCID: PMC7151912 DOI: 10.1016/b978-0-444-53717-1.01403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Suda G, Yamamoto Y, Nagasaka A, Furuya K, Kudo M, Chuganji Y, Tsukuda Y, Tsunematsu S, Sato F, Terasita K, Nakai M, Horimoto H, Sho T, Natsuizaka M, Ogawa K, Ohnishi S, Chuma M, Fujita Y, Abe R, Taniguchi M, Nakagawa M, Asahina Y, Sakamoto N. Serum granulysin levels as a predictor of serious telaprevir-induced dermatological reactions. Hepatol Res 2015; 45:837-45. [PMID: 25211174 DOI: 10.1111/hepr.12421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/27/2014] [Accepted: 09/04/2014] [Indexed: 12/11/2022]
Abstract
AIM Telaprevir-based therapy for chronic hepatitis C patients is effective; however, the high prevalence of dermatological reactions is an outstanding issue. The mechanism and characteristics of such adverse reactions are unclear; moreover, predictive factors remain unknown. Granulysin was recently reported to be upregulated in the blisters of patients with Stevens-Johnson syndrome (SJS). Therefore, we investigated the risk factors for severe telaprevir-induced dermatological reactions as well as the association between serum granulysin levels and the severity of such reactions. METHODS A total of 89 patients who received telaprevir-based therapy and had complete clinical information were analyzed. We analyzed the associations between dermatological reactions and clinical factors. Next, we investigated the time-dependent changes in serum granulysin levels in five and 14 patients with grade 3 and non-grade 3 dermatological reactions, respectively. RESULTS Of the 89 patients, 57 patients had dermatological reactions, including nine patients with grade 3. Univariate analysis revealed that grade 3 dermatological reactions were significantly associated with male sex. Moreover, serum granulysin levels were significantly associated with the severity of dermatological reactions. Three patients with grade 3 dermatological reaction had severe systemic manifestations including SJS, drug-induced hypersensitivity syndrome, and systemic lymphoid swelling and high-grade fever; all were hospitalized. Importantly, among the three patients, two patients' serum granulysin levels exceeded 8 ng/mL at onset and symptoms deteriorated within 6 days. CONCLUSION Male patients are at high risk for severe telaprevir-induced dermatological reactions. Moreover, serum granulysin levels are significantly associated with the severity of dermatological reactions and may be a predictive factor in patients treated with telaprevir-based therapy.
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Affiliation(s)
- Goki Suda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | | | | | - Ken Furuya
- Hokkaido Social Insurance Hospital, Hokkaido, Japan
| | - Mineo Kudo
- Sapporo Hokuyu Hospital, Hokkaido, Japan
| | | | - Yoko Tsukuda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Seiji Tsunematsu
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Fumiyuki Sato
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Katsumi Terasita
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Masato Nakai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Hiromasa Horimoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Takuya Sho
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Mitsuteru Natsuizaka
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Kouji Ogawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Shunsuke Ohnishi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Makoto Chuma
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Yasuyuki Fujita
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Riichiro Abe
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Miki Taniguchi
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mina Nakagawa
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Asahina
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
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Orrin E, Barnabas A, Agarwal K, Walsh SA. Cutaneous side-effects of antihepatitis C treatment: the U.K. experience. Br J Dermatol 2014; 172:292-3. [PMID: 24975744 DOI: 10.1111/bjd.13227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- E Orrin
- Department of Dermatology, King's College Hospital, Denmark Hill, London, SE5 9RS, U.K.
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Predictive factors for adverse dermatological events during pegylated/interferon alpha and ribavirin treatment for hepatitis C. J Clin Virol 2014; 60:190-5. [PMID: 24830933 DOI: 10.1016/j.jcv.2014.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis C (CHC) with pegylated interferon-alpha/ribavirin is associated with well-characterized dermatological adverse events (AEs), which can lead to premature discontinuation of treatment. OBJECTIVE To investigate the incidence and spectrum of dermatological AEs during CHC treatment with interferon-alpha plus ribavirin and analyzed factors predisposing patients to such reactions. STUDY DESIGN Between January 2008 and December 2012, 152 CHC patients who had received interferon/pegylated interferon plus ribavirin therapy were enrolled in this retrospective study. To determine which factors were associated with dermatological AE development, a Cox proportional-hazards regression analysis was performed. RESULTS Thirty dermatological AEs were recorded in 28 (18.4%) patients. These reactions included 14 (9.2%) patients with eczematous reactions, four (2.6%) patients with xerosis, three (2.0%) patients with new-onset or exacerbation of psoriasis, two (1.3%) patients with lichenoid eruption, two (1.3%) patients with diffuse folliculitis and one patient with lichen planus, alopecia areata, hypermelanosis, and necrosis of the skin and toenails. Application of the Cox proportional-hazards model revealed that age older than 60 years (HR=1.070; 95% CI: 1.043-1.096), pre-existing anaphylaxis/skin disease (HR=2.612; 95% CI: 1.593-3.324), cirrhosis (HR=1.863; 95% CI: 1.047-3.013), and treatment with pegylated interferon formulations (HR=1.930; 95% CI: 1.052-3.687) were associated with occurrence of dermatologic AEs. Twenty-seven (90%) skin conditions were classified as mild to moderate, while one case (3.3%) warranted premature discontinuation of treatment. CONCLUSION Dermatological AEs resulting from interferon-alpha/ribavirin treatment of CHC contribute to a wide spectrum involve the skin, mucous membrane, hair, and nails. These dermatological AEs correlated with older age, previous skin condition, cirrhosis, and use of pegylated interferon formulations.
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Federico A, Sgambato D, Cotticelli G, Gravina AG, Dallio M, Beneduce F, Ruocco E, Romano M, Loguercio C. Skin Adverse Events During Dual and Triple Therapy for HCV-Related Cirrhosis. HEPATITIS MONTHLY 2014; 14:e16632. [PMID: 24734094 PMCID: PMC3984470 DOI: 10.5812/hepatmon.16632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 12/19/2013] [Accepted: 12/30/2013] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Dermatological adverse events are an existing concern during treatment of hepatitis C virus infection. Peginterferon/ribavirin treatment is associated with well-characterized dermatological lesions tending towards a uniform entity of dermatitis. New telaprevir- or boceprevir-based triple-therapy has led to significant improvements in sustained virological response rates, although associated with an increase in cutaneous adverse events compared peginterferon/ribavirin alone. CASE PRESENTATION We report a case of a patient who discontinued telaprevir because of severe skin eruptions and who, during ribavirin and interferon treatment, after a period free of skin lesions, developed new dermatological lesions different than those experienced during telaprevir treatment. CONCLUSIONS Several adverse effects are associated to anti-HCV drugs, hence appropriate skin care management and follow-up are very important. A careful anamnesis before the initiation of triple therapy is necessary to identify previous dermatological diseases that could increase skin adverse effects incidence.
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Affiliation(s)
- Alessandro Federico
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
- Corresponding Author: Alessandro Federico, Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy. Tel: +39-815666723, Fax: +39-815666714, E-mail:
| | - Dolores Sgambato
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Gaetano Cotticelli
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Antonietta Gerarda Gravina
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Marcello Dallio
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Filippo Beneduce
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Marco Romano
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Carmela Loguercio
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
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Gönül M, Çakmak SK, Özcan N, Oǧuz ID, Özhamam E. Erythema Annulare Centrifugum due to Pegylated Interferon-α-2a plus Ribavirin Combination Therapy in a Patient with Chronic Hepatitis C Virus Infection. J Cutan Med Surg 2014; 18:65-8. [DOI: 10.2310/7750.2013.13051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Pegylated interferon-α combined with ribavirin is the current standard treatment for chronic hepatitis C virus infection. During interferon and ribavirin therapy, both local and generalized mucocutaneous adverse reactions have been reported. Erythema annulare centrifugum induced by this therapy regimen has not been reported previously. Case Report: A 29-year-old woman was referred to our clinic for a 1-week history of slightly pruritic annular erythematous eruptions on the lower extremities and hands. The eruptions had first occured on the hands 3 to 4 days after pegylated interferon-α-2a plus ribavirin combination therapy for hepatitis C virus infection. Histopathologic examination supported the diagnosis of erythema annulare centrifugum. The lesions completely regressed within 2 weeks after the cessation of treatment but recurred on similar localizations within 24 hours with the same therapy. It was thought that erythema annulare centrifugum was induced by pegylated interferon-α-2a plus ribavirin combination therapy. Conclusion: Erythema annulare centrifugum is considered an inflammatory skin disease with unknown etiology. It is thought to represent a hypersensitivity reaction to some triggering factors, including infections, immunologic disorders, malign neoplasms, foods, pregnancy, and drugs. We report the first case of erythema annulare centrifigum induced by pegylated interferon-α-2a plus ribavirin combination therapy.
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Affiliation(s)
- Müzeyyen Gönül
- From the Dermatology and Pathology Clinics, Ankara Numune Education and Research Hospital, Sihhiye, Ankara, Turkey
| | - Seray Külcü Çakmak
- From the Dermatology and Pathology Clinics, Ankara Numune Education and Research Hospital, Sihhiye, Ankara, Turkey
| | - Nimet Özcan
- From the Dermatology and Pathology Clinics, Ankara Numune Education and Research Hospital, Sihhiye, Ankara, Turkey
| | - Işil Deniz Oǧuz
- From the Dermatology and Pathology Clinics, Ankara Numune Education and Research Hospital, Sihhiye, Ankara, Turkey
| | - Esra Özhamam
- From the Dermatology and Pathology Clinics, Ankara Numune Education and Research Hospital, Sihhiye, Ankara, Turkey
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Shindo M, Terai I. Adverse Skin Reactions due to Ribavirin in Hepatitis C Combination Therapy with Pegylated Interferon-α2a. Case Rep Dermatol 2013; 5:379-81. [PMID: 24516409 PMCID: PMC3919427 DOI: 10.1159/000357516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The introduction of ribavirin to hepatitis C combination therapy with pegylated interferon (PEG-IFN)-α2a has improved sustained responses, but it has been accompanied by an increased incidence of cutaneous side effects. Most cases of drug eruption caused by ribavirin and PEG-IFN-α2 or IFN-α combination therapy were not severe and we progressed without discontinuation of the antiviral treatment. We describe a 59-year-old Japanese woman with a chronic hepatitis C infection who developed erythema during PEG-IFN-α2a and ribavirin combination therapy. The eruption at the injection site of IFN occurred after each injection, and then, eruption on her exposed skin was observed. Twenty milligrams of prednisolone was administered. The eruption recurred after each administration of prednisolone and ribavirin. She finally had infiltrative erythema without any mucosal symptoms on her body. It seemed to be an erythema multiforme type drug eruption of PEG-IFN-α2a, ribavirin and/or fluvastatin sodium from the clinical course. The lymphocyte transformation test (LTT) of ribavirin was positive. This is the first case of a positive result of an LTT for ribavirin. A photosensitive type drug eruption with ribavirin treatment has been reported. We should not only consider IFN, but also ribavirin in case of a generalized eruption, especially on an exposed area with combination therapy for HCV.
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Affiliation(s)
- Masahisa Shindo
- Department of Dermatology, National Hospital Organization Hamada Medical Center, Hamada, Japan
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Direct-acting antiviral-associated dermatitis during chronic hepatitis C virus treatment. Am J Clin Dermatol 2013; 14:497-502. [PMID: 23775427 DOI: 10.1007/s40257-013-0035-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Telaprevir and boceprevir are novel protease inhibitors recently approved for treatment of chronic hepatitis C virus infection, and have gained widespread use. Skin rash has been reported frequently in patients treated with telaprevir, but less commonly with boceprevir. Despite a high incidence in clinical trials, the telaprevir-related eruption has not been fully described in the literature. We describe six patients treated with telaprevir and three treated with boceprevir who developed skin rash related to the antiviral medication. Four patients treated with telaprevir developed laboratory abnormalities and/or systemic symptoms and five required discontinuation of their antiviral medication because of these adverse effects, including two patients who fit criteria for drug reaction with eosinophilia and systemic symptoms (DRESS). Patients with boceprevir-related rash had a milder course and none required discontinuation of the medication. This report confirms that cutaneous adverse effects from telaprevir and boceprevir are common. Patients treated with telaprevir may have a more severe course and more frequently require discontinuation of their antiviral therapy due to extensive rash or laboratory abnormalities. Dermatologists must be aware of these cutaneous adverse effects, as early intervention with topical corticosteroids and antihistamines may minimize the severity of the eruption and allow patients to complete antiviral therapy.
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9
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Advances in the Diagnosis of Drug Eruptions. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] Open
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de la Torre C, Suh Oh H. Novedades en el diagnóstico de las toxicodermias. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:782-8. [DOI: 10.1016/j.ad.2012.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 11/13/2012] [Accepted: 11/24/2012] [Indexed: 11/26/2022] Open
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Abstract
Antiviral treatment for hepatitis C virus infection has dramatically changed with the advent of triple therapy including telaprevir or boceprevir, which is associated with a new spectrum of adverse events. These may lead to dosage reduction and early discontinuation of therapy. An increase in the frequency and severity of anaemia was reported in clinical trials for both drugs, and skin disorders including rash and pruritus occurred more frequently with the telaprevir-based regimen. The first-line management of anaemia is ribavirin dose reductions. In cirrhotic patients, aggressive ribavirin dosage reductions, erythropoietin alpha and blood transfusions are effective in managing anaemia. Several deaths and cases of severe infections and hepatic decompensation were reported in cirrhotics treated in real-life setting. Patients with platelet count ≤ 100,000/mm(3) and serum albumin < 35 g/L should not be treated with triple therapy as it is related to a high risk of developing severe complications. The management of rashes, if well planned, does not require telaprevir discontinuation. However, approximately 5% of rashes were severe and a few cases were classified as severe cutaneous adverse reactions leading to treatment discontinuation. Successful treatment can be enhanced by a strong patient support network including a multidisciplinary team.
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Affiliation(s)
- Christophe Hézode
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; INSERM U955, Créteil, France.
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Torii H, Sueki H, Kumada H, Sakurai Y, Aoki K, Yamada I, Ohtsuki M. Dermatological side-effects of telaprevir-based triple therapy for chronic hepatitis C in phase III trials in Japan. J Dermatol 2013; 40:587-95. [PMID: 23734933 DOI: 10.1111/1346-8138.12199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/08/2013] [Indexed: 12/12/2022]
Abstract
Telaprevir-based triple therapy is highly effective for chronic hepatitis C. However, concern has been expressed over the high frequency and severity of its dermatological side-effects compared with those associated with peginterferon (PEG-IFN) and ribavirin (RBV) therapy. Thus, here, we evaluated the dermatological adverse reactions of telaprevir-based triple therapy in Japanese multicenter phase III clinical trials in an attempt to characterize the dermatological side-effects and establish appropriate management plans. In these trials, 126 treatment-naïve patients and 141 treatment-failure patients were administrated telaprevir, PEG-IFN-α-2b and RBV for 12 weeks followed by PEG-IFN-α-2b and RBV for another 12 weeks (T12/PR24 group), and 63 treatment-naïve patients were administrated PEG-IFN-α-2b and RBV for 48 weeks (PR48 group). Dermatological adverse reactions developed in over 80% patients in both groups, and most of them were grade 1 or 2. In the T12/PR24 group, there were more grade 2 or grade 3 events, and the time to onset was earlier than that in the PR48 group. Most reactions could be managed with topical corticosteroids and oral antihistamines, and the rates of discontinuation due to dermatological reactions were not high even in the T12/PR24 group. In the T12/PR24 group, however, two cases of Stevens-Johnson syndrome and one case of drug rash with eosinophilia and systemic symptoms, which corresponds to drug-induced hypersensitivity syndrome in Japan, were reported. For appropriate treatments of individual dermatological adverse reactions, the judgment of discontinuation of antiviral drugs and treatment based on the severity are extremely important in this triple therapy.
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Affiliation(s)
- Hideshi Torii
- Division of Dermatology, Social Insurance Central General Hospital, Tokyo, Japan.
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Slim J, Afridi MS. Managing adverse effects of interferon-alfa and ribavirin in combination therapy for HCV. Infect Dis Clin North Am 2013; 26:917-29. [PMID: 23083824 DOI: 10.1016/j.idc.2012.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This article focuses on the adverse effects of hepatitis C therapy, which includes pegylated interferon alfa-2a or -2b with ribavirin. The hepatitis C virus provider should remain cognizant of the various organ systems that can be affected, which adverse effects should be addressed with the help of an expert, and the presentation of symptoms as they occur throughout the course of therapy. A systems-based approach should help to characterize the nature of the adverse effects that patients experience, and also to determine when patients should be further investigated by a consultant.
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Affiliation(s)
- Jihad Slim
- St. Michaels Medical Center, 111 Central Avenue, Newark, NJ 07102, USA.
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Teixeira R, Nascimento YDA, Crespo D. Safety aspects of protease inhibitors for chronic hepatitis C: adverse events and drug-to-drug interactions. Braz J Infect Dis 2013; 17:194-204. [PMID: 23490868 PMCID: PMC9427372 DOI: 10.1016/j.bjid.2012.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/16/2012] [Indexed: 12/24/2022] Open
Abstract
The standard of care therapy of chronic hepatitis C with the combination of pegylated interferon and ribavirin for 24 or 48 weeks was a remarkable accomplishment of the past decade. However, sustained virological responses rates of about 80% (genotypes 2–3) and 50% (genotype 1) were not satisfactory especially for patients infected with genotype 1. Important advances in the biology of HCV have made possible the development of the direct-acting antiviral agents boceprevir and telaprevir with substantial increase in the rates of sustained virological response with shorter duration of therapy for a large number of patients. However, the complexity of triple therapy is higher and several new side effects are expected suggesting greater expertise in the patient management. Anemia and disgeusia are frequent with boceprevir while cutaneous rash, ranging from mild to severe, is expected with telaprevir. Higher risk of drug–drug interactions demand further clinical consideration of the previous well-known adverse events of pegylated interferon and ribavirin. Identification and prompt management of these potential new problems with boceprevir and telaprevir are crucial in clinical practice for optimizing treatment and assuring safety outcomes to HCV-genotype 1 patients.
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Affiliation(s)
- Rosângela Teixeira
- Viral Hepatitis Clinic, Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Picard O, Cacoub P. Dermatological adverse effects during genotype-1 hepatitis C treatment with the protease inhibitors telaprevir and boceprevir. Patient management. Clin Res Hepatol Gastroenterol 2012; 36:437-40. [PMID: 22483956 DOI: 10.1016/j.clinre.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 02/25/2012] [Indexed: 02/04/2023]
Affiliation(s)
- Odile Picard
- Department of infectious and communicable diseases, Hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Li Z, Ji F, Zheng Y, An J, Peng Z. Pegylated interferon, but not conventional interferon therapy induced severe skin lesions. Ann Hepatol 2012. [PMID: 22700642 DOI: 10.1016/s1665-2681(19)31475-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Dermatological side effects of hepatitis C and its treatment: patient management in the era of direct-acting antivirals. J Hepatol 2012; 56:455-63. [PMID: 21884670 DOI: 10.1016/j.jhep.2011.08.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 07/26/2011] [Accepted: 08/02/2011] [Indexed: 12/15/2022]
Abstract
Dermatological adverse events (AEs) are an existing concern during hepatitis C virus (HCV) infection and peginterferon/ribavirin treatment. HCV infection leads to dermatological and muco-cutaneous manifestations including small-vessel vasculitis as part of the mixed cryoglobulinemic syndrome. Peginterferon/ribavirin treatment is associated with well-characterized dermatological AEs tending towards a uniform entity of dermatitis. New direct-acting antivirals have led to significant improvements in sustained virologic response rates, but several have led to an increase in dermatological AEs versus peginterferon/ribavirin alone. In telaprevir trials, approximately half of treated patients had rash. More than 90% of these events were Grade 1 or 2 (mild/moderate) and in the majority (92%) of cases, progression to a more severe grade did not occur. In a small number of cases (6%), rash led to telaprevir discontinuation, whereupon symptoms commonly resolved. Dermatological AEs with telaprevir-based triple therapy were generally similar to those observed with peginterferon/ribavirin (xerosis, pruritus, and eczema). A few cases were classified as severe cutaneous adverse reaction (SCAR), also referred to as serious skin reactions, a group of rare conditions that are potentially life-threatening. It is therefore important to distinguish between telaprevir-related dermatitis and SCAR. The telaprevir prescribing information does not require telaprevir discontinuation for Grade 1 or 2 (mild/moderate) rash, which can be treated using emollients/moisturizers and topical corticosteroids. For Grade 3 rash, the prescribing information mandates immediate telaprevir discontinuation, with ribavirin interruption (with or without peginterferon) within 7 days of stopping telaprevir if there is no improvement, or sooner if it worsens. In case of suspicion or confirmed diagnosis of SCAR, all study medication must be discontinued.
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Hézode C. Boceprevir and telaprevir for the treatment of chronic hepatitis C: safety management in clinical practice. Liver Int 2012; 32 Suppl 1:32-8. [PMID: 22212569 DOI: 10.1111/j.1478-3231.2011.02707.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Effective management of adverse events (AEs) is important to prevent treatment discontinuation and optimize hepatitis C virus infection eradication rates. The addition of direct-acting antiviral agents, telaprevir (TVR) or boceprevir to pegylated interferon (PEG-IFN) and ribavirin (RBV) represents a new era of therapy associated with an improvement in treatment response rates and an impairment of the safety profile compared to PEG-IFN/RBV. An increase in the frequency and severity of anaemia was reported in clinical trials for both drugs, and skin disorders including rash and pruritus occurred more frequently with the TVR-based regimen. These AEs are generally manageable and do not lead to early discontinuation. The management of anaemia has not been clearly established, and the impact of RBV dose reductions and erythropoietin alpha use on treatment efficacy and safety must be clarified. The management of rashes, which were mild and moderate in more than 90% of the cases, is well planned, does not require TVR discontinuation and can be treated using emollients and topical corticosteroids. However, approximately 5% of rashes were severe, and a few cases were classified as severe cutaneous adverse reactions leading to treatment discontinuation.
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Affiliation(s)
- Christophe Hézode
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.
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19
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Abstract
The current treatment of chronic hepatitis C is the triple combination of pegylated interferon, ribavirin and a new direct-acting antiviral [either telaprevir (TVR) or boceprevir (BOC)]. This new association produces better viral response rates, but may induce or enhance adverse events, which can lead to discontinuation of treatment. TVR regimens are associated with an increased risk of dermatological side-effects such as rash, albeit generally mild. In these cases, optimal skincare treatments, including emollient creams and topical corticosteroids, allow the continuation of antiviral treatment. In a minority of cases, the rash may be severe and life-threatening, leading to immediate discontinuation of all treatments. The goal for the physician is to differentiate severe cutaneous adverse reactions (SCARs), including DRESS (drug reactions with eosinophilia and systemic symptoms). Anaemia is also more frequent with triple combinations using TVR or BOC. The management of anaemia requires the use of erythropoietin alpha (EPO) and the need to decrease ribavirin doses. Thus, monitoring haemoglobin has to be more frequent in difficult-to-treat patients such as cirrhosis cases; nevertheless, despite the use of EPO and ribavirin-dose adaptation, blood transfusion is sometimes still required. Thus, triple combination therapy with a DAA is effective, but it increases the rate of adverse events, and adds to the well-known adverse effects of pegylated interferon and ribavirin. This suggests the need for a different clinical and biological management of patients treated with the triple combination.
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Affiliation(s)
- Isabelle Rosa
- Department of Hepato-gastroenterology, Centre Hospitalier Intercommunal de Créteil, France.
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Barut S, Yuksek J, Sezer E, Gunal O, Koseoglu D. Morbilliform drug eruption due to pegylated α-interferon can show complete regression after switching to non-pegylated interferon. J Dermatol 2011; 38:479-81. [PMID: 21352322 DOI: 10.1111/j.1346-8138.2010.01088.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pegylated or non-pegylated α-interferon are frequently used medications for the treatment of both chronic hepatitis B and chronic hepatitis C. Skin disorders, which are mainly comprised of eczematous dermatitis, are frequently seen during treatment with this drug. However, drug eruption or morbilliform eruptions due to interferons have been rarely reported so far. We herein describe a patient who developed morbilliform drug eruption under treatment with pegylated interferon. She was able to continue treatment after switching from pegylated interferon to conventional interferon.
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Affiliation(s)
- Sener Barut
- Department of Infectious Diseases and Clinical Microbiology, Gaziosmanpasa University, Faculty of Medicine, Tokat, Turkey
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Abstract
Hepatitis C is one of the leading causes of liver disease in the United States, affecting more than 4 million individuals. The current treatment regimen involves pegylated interferon in combination with ribavirin. Although antiviral treatment has been associated with a greater than 50% sustained viral response rate, the adverse effects have proven to be detrimental to quality of life and therapy adherence, and consequently lead to lower sustained viral response rates. This article identifies the most frequently described complications associated with pegylated interferon and ribavirin. The active management of these complications is discussed, including both preventive and empiric treatments.
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Affiliation(s)
- Hubert Sung
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA USA
| | - Michael Chang
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
| | - Sammy Saab
- Department of Surgery, University of California at Los Angeles, Los Angeles, CA USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA USA
- Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 USA
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Negro F. Adverse effects of drugs in the treatment of viral hepatitis. Best Pract Res Clin Gastroenterol 2010; 24:183-92. [PMID: 20227031 DOI: 10.1016/j.bpg.2009.10.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 10/01/2009] [Indexed: 01/31/2023]
Abstract
The hepatitis B virus (HBV) and the hepatitis C virus (HCV) affect approximately 400-500 million individuals worldwide. Both infections are characterised by a significant morbidity and mortality: chronic hepatitis B and C may evolve towards the development of cirrhosis and primary hepatocellular carcinoma. During the last two decades, several new antivirals have been developed that are active against HBV and HCV, allowing sustained cure rates in a significant proportion of patients. All these drugs have side effects, which may represent a major barrier to achieve cure in many patients in need. I will review the most common adverse events reported during the therapy of chronic hepatitis B and C, with some recommendations for proper management.
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Affiliation(s)
- Francesco Negro
- Divisions of Clinical Pathology, University Hospitals, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
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Sato M, Sueki H, Iijima M. Repeated episodes of fixed eruption 3 months after discontinuing pegylated interferon-alpha-2b plus ribavirin combination therapy in a patient with chronic hepatitis C virus infection. Clin Exp Dermatol 2009; 34:e814-7. [PMID: 19817760 DOI: 10.1111/j.1365-2230.2009.03560.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a 73-year-old man who developed repeated episodes of erythematous, bullous plaques beginning 3 months after discontinuation of combination treatment with pegylated interferon (IFN)-alpha-2b and ribavirin for hepatitis C virus infection. The first episode resolved within a week without treatment, but the lesions recurred about once a month and were associated with high fever. Physical examination found darkly reddish, pigeon-egg-sized erythematous plaques with occasional flaccid blisters, predominantly on the trunk and proximal limbs, lip and penis. Histological examination showed well-demarcated foci of full-thickness epidermal necrosis and exocytosis of lymphoid cells. Pegylated IFN-alpha2b and ribavirin produced no response in lymphocyte stimulation tests. Systemic prednisolone led to rapid healing of skin lesions at the time of the fifth episode, leaving pigmented macules, but lesions recurred at the same sites within weeks of discontinuation of this treatment. It is uncertain whether this case represented a prolonged drug rash provoked by pegylated IFN-alpha2b or a fixed eruption in response to another antigen.
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Affiliation(s)
- M Sato
- Division of Dermatology, Showa University Fujigaoka Hospital, Yokohama, Japan
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LÜBBE J. Adverse skin reactions associated with hepatitis C treatment: Comment. J Dermatol 2008; 35:250; author reply 251. [DOI: 10.1111/j.1346-8138.2008.00458.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scheler M, Proelss J, Bräuninger W, Bieber T, Wenzel J. Generalized lichen nitidus with involvement of the palms following interferon alpha treatment. Dermatology 2007; 215:236-9. [PMID: 17823522 DOI: 10.1159/000106582] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Accepted: 03/05/2007] [Indexed: 11/19/2022] Open
Abstract
Lichen nitidus is an uncommon dermatosis of unknown etiology. Here we present the case of a generalized lichen nitidus with involvement of the palms in a patient with hepatitis C after systemic treatment with interferon alpha and ribavirin. Furthermore in our patient we could show a strong lesional expression of MxA, a protein specifically induced by type I interferon. It is tempting to speculate that interferon alpha may be involved in the pathogenesis of lichen nitidus.
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Affiliation(s)
- Marina Scheler
- Department of Dermatology, University of Bonn, Bonn, Germany.
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Berk DR, Mallory SB, Keeffe EB, Ahmed A. Dermatologic disorders associated with chronic hepatitis C: effect of interferon therapy. Clin Gastroenterol Hepatol 2007; 5:142-51. [PMID: 16919505 DOI: 10.1016/j.cgh.2006.06.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic hepatitis C virus infection (HCV) is associated with extrahepatic manifestations, including such dermatologic conditions as mixed cryoglobulinemia, porphyria cutanea tarda, and lichen planus. Patients with chronic HCV and extrahepatic manifestations are often excluded from clinical trials evaluating interferon (IFN) therapy due to concerns about poor response, adverse events, and toxicity. Thus, data regarding the efficacy of IFN not only on the underlying chronic HCV, but also on extrahepatic manifestations, are limited in these patients. Case reports suggest that the response of dermatologic extrahepatic manifestations to IFN in patients with chronic HCV is highly variable. This review summarizes available data on dermatologic conditions associated with chronic HCV and their response to IFN therapy.
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Affiliation(s)
- David R Berk
- Division of Dermatology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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