Fatigue interferon alfa

The adverse effects of interferon alfa-2b include fever and a fiulike syndrome of muscle ache, fatigue, headache, anorexia, and nausea. Other less common side effects include leukopenia, diarrhea, dizziness, and skin rash. 

A 64-year-old man with no history of allergy had progressive fatigue, loss of appetite, and facial edema after 6 months of interferon alfa-2b treatment for chronic hepatitis C (319). Angioedema was diagnosed and it resolved after withdrawal of interferon alfa and a short course of prednisolone. Serum immunoglobuhn E and plasma bradykinin concentrations were raised, but the Cl esterase inhibitor and serum complement concentrations were normal. 

The use of intraspinal interferon alfa (1 MU three times a week for 4 weeks) in 22 patients with neoplastic meningitis was associated with frequent adverse effects that mostly manifested as chronic fatigue syndrome in 91% of patients (severe in 45%) and arachnoiditis in 73% (severe in 9%) (402). Interferon alfa-induced immune dysregulation in an immunologically predisposed patient was suggested to account for this complication. 

The general toxicity of interferon beta is very similar to that of interferon alfa (2), with no apparent differences between the two recombinant preparations with any route of injection (SEDA-20, 332) (3-6). In multiple sclerosis, fatigue and a transient flu-like syndrome responsive to paracetamol or the combination of paracetamol plus prednisone have been observed in about 60% of patients during the first weeks of treatment, and tachyphylaxis usually developed after several doses (7). Patients with chronic progressive disease are more likely to discontinue treatment because of adverse effects (8). 

The most common adverse effects reported in two large multicenter studies were fever (60%), leukopenia (43%), increased serum aspartate transaminase activity (30%), anorexia (30%), thrombocytopenia (25%), fatigue (21%), nausea, and vomiting (17%) (18,19). Compared with subcutaneous administration, intravenous interferon alfa is associated with similar adverse effects of greater severity and frequency (20,21). 

Nervous system Interferon alfa has been used to investigate pathways by which innate immune cytokines affect the brain and behavior [38 ]. There were reduced motor speed and reaction times and slower response times in the rapid visual information processing task in patients who were treated with interferon alfa and ribavirin. Reduced motor speed correlated with increased symptoms of depression and fatigue. 

Typical side effects are constitutional in nature, including a flu-like syndrome within 6 hours after dosing in more than 30% of patients that tends to resolve upon continued administration. Other potential adverse effects include thrombocytopenia, granulocytopenia, elevation in serum aminotransferase levels, induction of autoantibodies, nausea, fatigue, headache, arthralgias, rash, alopecia, anorexia, hypotension, and edema. Severe neuropsychiatric side effects may occur. Absolute contraindications to therapy are psychosis, severe depression, neutropenia, thrombocytopenia, symptomatic heart disease, decompensated cirrhosis, uncontrolled seizures, and a history of organ transplantation (other than liver). Alfa interferons are abortifacient in primates and should not be administered in pregnancy. 

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