Interferon therapy thrombocytopenia with

Because a-interferon therapy can exacerbate autoimmune disorders, it is important to exclude autoimmune diagnoses before initiating therapy. Thrombocytopenia and granulocytopenia are more common in patients with cirrhosis and hypersplenism. The psychiatric complications are especially severe in those with severe liver disease, occur in up to 20% of patients, and are the most common dose-limiting side effects. Therapy should be discontinued if serious complications occur. The dose of a-interferon must be reduced in 10% to 40% of patients. Treatment must be discontinued because of adverse effects in 5% to 10% of patients. For many patients, reassurance that the side effects are therapy related, not severe, and will disappear when therapy is stopped is sufficient. It is always important to reassure both patient and family, especially when psychiatric side effects are evident. These points are critical given that patient adherence is crucial to the ultimate success of HCV treatment. ... 

Autoimmune diseases have been reported to be more frequent in human subjects treated with several recombinant cytokines [38], For instance, increased titers or the new occurrence of autoantibodies have been observed in hepatitis C patients treated with the recombinant interferons-alpha (IFNa). Quite a few clinical case reports describe the development of organ-specific as well as systemic autoimmune diseases including systemic lupus erythematosus, insulin-dependent type I diabetes mellitus, autoimmune thrombocytopenia, autoimmune hemolytic anemia, myasthenia gravis, and autoimmune thyroiditis in patients under IFNa therapy. Although the mechanism involved is not fully elucidated, the available data support the pathogenic potential of IFNa in autoimmunity [31]. In contrast, autoimmune effects associated with IFNp therapy are thought to be of lesser concern based on the current clinical evidence [38], Thyroid autoimmunity in contrast to other autoimmune diseases is frequent in patients treated with recombinant interleukin-2 (rIL-2). Thus, among 281 previously euthyroid cancer patients treated with rIL-2, up to 41%... 

Kato H, Fujishiro T, Narita M. A case of severe thrombocytopenia in a patient with chronic hepatitis C caused by a single administration of pegylated interferon a 2a subsequent to 48 weeks of pegylated interferon a 2b plus ribavirin therapy. Intern Med 2010 49(16) 1741-4. 

Observational studies In a retrospective study of the effects of telaprevir based triple therapy (telaprevir in combination with peg interferon alfa (peg IFNa) + RBV on nine patients) four patients were hospitalised because of adverse events (bacterial pneumonia, tacrolimus overdosing with renal failure, infectious enteritis, exacerbated diabetes mellitus and raised liver enzymes) [76=]. Anaemia (n=4), thrombocytopenia (n=4) and skin reactions (n = 3) were also reported. 

---