Interferon alfa management

The clinical features, management, and prognosis of psychiatric symptoms in patients with chronic hepatitis C have been reviewed using data from 943 patients treated with interferon alfa (85%) or interferon beta (15%) for 24 weeks (333). Interferon-induced psychiatric symptoms were identified in 40 patients (4.2%) of those referred for psychiatric examination. They were classified in three groups according to the clinical profile 13 cases of generalized anxiety disorder (group A), 21 cases of... 

Cognitive defects, depression, and mania can occur in patients taking interferon alfa. Interferon alfa-induced psychiatric adverse effects and their recommended management have been comprehensively reviewed (383,384,385). 

The adverse effects of interferon alfa have mostly been reported after systemic administration, as intranasal use was not associated with more frequent adverse effects than placebo (13). Almost aU patients treated with interferon alfa have experienced adverse effects, most of which are mild to moderate in intensity and easily manageable without withdrawal of treatment (14). The incidence and profile of adverse effects reported with the available tjfpes... 

Thrombotic thrombocytopenic purpura is a possible complication of interferon alfa in patients with chronic myelogenous leukemia, and can develop even after a successful prolonged (2-3 years) treatment (234). Complete recovery is expected after prompt medical management with plasma exchange and glucocorticoids. 

The management of patients with chronic hepatitis C and associated features of autoimmune disease carries the risk of exacerbating the underlying disease. Different treatment strategies, including interferon alfa alone or combined with ribavirin or glucocorticoids, or no treatment, have been discussed (345). 

Kirkwood JM, Bender C, Agarwala S, et al. Mechanisms and management of toxicities associated with high-dose interferon alfa-2b therapy. J Clin Oncol 2002 20 3703-3718. 

Ocular sarcoidosis has been reported in three patients, in two of whom conventional interferon alfa was used and in one peginterferon alfa-2b all had granulomatous panuveitis with choroidal granulomata of various sizes [42 ]. All had also taken ribavirin. The intraocular inflammation was managed by reducing the dose of interferon and all patients received topical glucocorticoids. 

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