The Interferon Blues & Interferon: The Great Initiator (of Side Effects)

[Guest guest]

20 Clinical Pearls: Viral Hepatitis

from Infections in Medicine ®

The Interferon Blues

Depression is no longer seen as an absolute contraindication to IFN therapy,

but it requires close monitoring.[24] However, severe depression or suicidal

ideation, either preexisting or appearing during treatment, precludes IFN

therapy. A simple depression test (S6 questionnaire) is helpful in

determining whether the patient is depressed and, if so, in estimating the

severity of symptoms. Mild depression is often alleviated by treatment with

selective serotonin reuptake inhibitors. Patients with a history of mild

depression may benefit from initiation of antidepressant therapy before

treatment with IFN. For patients with moderate depression, consultation with

a psychiatrist is recommended.

Interferon: The Great Initiator (of Side Effects)

IFN alfa can lead to a surprising variety of rare but very severe side

effects, often in the form of autoimmune syndromes. For example,

sarcoidosis, a rare IFN-associated side effect, can progress to

life-threatening illness, as illustrated by a 47-year-old woman with HCV

genotype 3a infection in whom fever and respiratory failure developed 20

days after completion of a course of treatment with PEG IFN alfa-2b and

ribavirin. Chest x-ray films showed " atypical pneumonia " (Figure 3), and

transbronchial biopsy demonstrated granulomatous inflammation (Figure 4).

Corticosteroids were given concomitantly with antituberculous medication

(until PCR testing for Mycobacterium tuberculosis complex showed negative

results), and the patient slowly recovered after 9 days on mechanical

ventilation. The HCV response to IFN was sustained.

http://www.medscape.com/viewarticle/457918_8

[Guest guest]

20 Clinical Pearls: Viral Hepatitis

from Infections in Medicine ®

The Interferon Blues

Depression is no longer seen as an absolute contraindication to IFN therapy,

but it requires close monitoring.[24] However, severe depression or suicidal

ideation, either preexisting or appearing during treatment, precludes IFN

therapy. A simple depression test (S6 questionnaire) is helpful in

determining whether the patient is depressed and, if so, in estimating the

severity of symptoms. Mild depression is often alleviated by treatment with

selective serotonin reuptake inhibitors. Patients with a history of mild

depression may benefit from initiation of antidepressant therapy before

treatment with IFN. For patients with moderate depression, consultation with

a psychiatrist is recommended.

Interferon: The Great Initiator (of Side Effects)

IFN alfa can lead to a surprising variety of rare but very severe side

effects, often in the form of autoimmune syndromes. For example,

sarcoidosis, a rare IFN-associated side effect, can progress to

life-threatening illness, as illustrated by a 47-year-old woman with HCV

genotype 3a infection in whom fever and respiratory failure developed 20

days after completion of a course of treatment with PEG IFN alfa-2b and

ribavirin. Chest x-ray films showed " atypical pneumonia " (Figure 3), and

transbronchial biopsy demonstrated granulomatous inflammation (Figure 4).

Corticosteroids were given concomitantly with antituberculous medication

(until PCR testing for Mycobacterium tuberculosis complex showed negative

results), and the patient slowly recovered after 9 days on mechanical

ventilation. The HCV response to IFN was sustained.

http://www.medscape.com/viewarticle/457918_8