Interferon alfa Prednisone

Perrillo, R.P., E.R. Schifl G.L. Davis, et al., A randomized, controlled trial of interferon alfa-2b alone and after prednisone withdrawal for the treatment of chronic hepatitis... 

Autoreactive tissue disorders (autoimmune diseases)2 Prednisone, cyclophosphamide, methotrexate, interferon alfa and interferon beta, azathioprine, cyclosporine, infliximab, etanercept, adalimumab Often good, variable... 

There was significant bleeding with hematomas in association with an inhibitor of factor VIII in a 58-year-old man who took interferon alfa for 1 year for chronic myelogenous leukemia (239). The factor VIII inhibitor, which was markedly raised, disappeared within 6 weeks of interferon alfa withdrawal and prednisone treatment. 

The early impression that interferon alfa, alone or in combination with ribavirin, could reactivate or cause new subcutaneous sarcoid nodules and pulmonary or generalized sarcoidosis, has been confirmed by several reports, with prompt recovery after interferon alfa withdrawal (SED-13, 1097) (SEDA-20, 330) (SEDA-22, 404). The incidence may have been underestimated in one series, 3 patients out of 60 who received interferon alfa alone or combined with ribavirin developed pulmonary sarcoidosis (351). In a review of 27 cases, the time to onset was 15 days to 30 months, and there were dermatological signs in 50% (352). Five patients had also taken ribavirin, but an enhanced T cell immune reaction from the combination of interferon alfa plus ribavirin is speculative. However, the association of cutaneous or systemic sarcoidosis with interferon alfa, alone or in association with ribavirin, has been exemplified by various reports (353,354), including one patient whose sarcoidosis resolved with prednisone despite continued interferon alfa treatment (355). 

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). 

In 10 myeloma patients the AUC of melphalan 250 microgram/kg was re-dueed by 13% when it was given 5 hours after the administration of human interferon alfa (7 x 10 units/m ), possibly due to the fever caused by the interferon. The elinieal importance of this is uncertain but the authors of the report suggest that despite this small reduction in the AUC, the cytotoxicity of the melphalan is increased by the fever. The use of interferon alfa with melphalan and prednisone in multiple myeloma has been associated with more adverse effects. 

Cooper MR, Dear K, McIntyre OR, Ozer H, Ellerton J, Canellos G, Bernhardt B, Duggan D, Faragher D, Schiffer C. A randomized clinical ttial comparing melphalan/prednisone with or without interferon alfa-2b in newly diagnosed patients with multiple myeloma a Cancer and Leukemia Group B study. J Clin Oncol (1993) 11, 155-60. 

A single intramuscular dose of recombinant human interferon alfa-2a 18 million units was given to 8 healthy subjects alone, or after one day of either aspirin 650 mg every 4 hours, paracetamol 650 mg every 4 hours or prednisone 40 mg daily, for a total of 8 days. None of these additional drugs reduced the interferon adverse effects of fever, chills, headache, or myalgia. Only prednisone appeared to reduce one of the two measures of interferon activity. In a later similar study by the same research group, the effect of the same drugs and doses (started 3 days before the interferon) was evaluated with a lower dose of interferon alfa-2a (3 million units). When data for aspirin, paracetamol or prednisone was combined the... 

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