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Soleimani B, Murray K, Hunt D. Established and Emerging Immunological Complications of Biological Therapeutics in Multiple Sclerosis. Drug Saf 2020; 42:941-956. [PMID: 30830572 DOI: 10.1007/s40264-019-00799-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Biologic immunotherapies have transformed the treatment landscape of multiple sclerosis. Such therapies include recombinant proteins (interferon beta), as well as monoclonal antibodies (natalizumab, alemtuzumab, daclizumab, rituximab and ocrelizumab). Monoclonal antibodies show particular efficacy in the treatment of the inflammatory phase of multiple sclerosis. However, the immunological perturbations caused by biologic therapies are associated with significant immunological adverse reactions. These include development of neutralising immunogenicity, secondary immunodeficiency and secondary autoimmunity. These complications can affect the balance of risks and benefits of biologic agents, and 2018 saw the withdrawal from the market of daclizumab, an anti-CD25 monoclonal antibody, due to concerns about the development of severe, unpredictable autoimmunity. Here we review established and emerging risks associated with multiple sclerosis biologic agents, with an emphasis on their immunological adverse effects. We also discuss the specific challenges that multiple sclerosis biologics pose to drug safety systems, and the potential for improvements in safety frameworks.
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Affiliation(s)
| | - Katy Murray
- Anne Rowling Clinic, University of Edinburgh, Edinburgh, UK
| | - David Hunt
- Anne Rowling Clinic, University of Edinburgh, Edinburgh, UK. .,MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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Ozturk M, Basoglu F, Yilmaz M, Ozagari AA, Baybas S. Interferon β associated nephropathy in a Multiple Sclerosis patient: A case and review. Mult Scler Relat Disord 2016; 9:50-3. [PMID: 27645343 DOI: 10.1016/j.msard.2016.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 04/12/2016] [Accepted: 06/25/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Interferon beta (IFN β) subtypes are largely used as immunomodulatory agents in Multiple Sclerosis (MS) treatment. While being generally well tolerated, they can cause various side effects. Adverse effects related to kidney are rarely reported. CASE REPORT We report a 32 years old male patient who developed nephrotic syndrome while receiving IFN β for MS. Biopsy showed focal segmental glomerulosclerosis. He went into remisson after cessation of drug and with the aid of angiotensin II antagonists. Here, we report this case and a review of similar cases reported in literature. CONCLUSIONS Although it's a rare adverse effect and tend to show good prognosis physicians should pay careful attention to symptoms and findings of nephropathy during follow ups of patients under treatment with these agents.
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Affiliation(s)
- Musa Ozturk
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Tevfik Saglam Cad No:25/2, 34147 Bakirkoy, Istanbul, Turkey.
| | - Fulya Basoglu
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Tevfik Saglam Cad No:25/2, 34147 Bakirkoy, Istanbul, Turkey.
| | - Murvet Yilmaz
- Department of Nephrology, Bakirkoy Dr Sadi Konuk Reasaerch and Training Hospital, Tevfik Saglam Street No:11, 34147 Bakirkoy, Istanbul, Turkey.
| | - Ayse Aysim Ozagari
- Department of Pathology, Sisli Hamidiye Etfal Research and Training Hospital, Halaskargazi Boulevard, Etfal Street, 34360 Sisli, Istanbul, Turkey.
| | - Sevim Baybas
- Department of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Tevfik Saglam Cad No:25/2, 34147 Bakirkoy, Istanbul, Turkey.
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Ikeda K, Okamoto T, Yamamura T, Ohsawa I, Furutera R, Murata M. [Nephrotic syndrome in multiple sclerosis patients who had undergone long-term interferon β-1b therapy]. Rinsho Shinkeigaku 2013; 53:19-23. [PMID: 23328061 DOI: 10.5692/clinicalneurol.53.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 59-year-old man (case 1) with multiple sclerosis (MS) presented with shortness of breath and general fatigue. He had been treated using interferon β-1b (IFNβ-1b) since he was 51 years of age. Laboratory test results showed hypoproteinemia and hypoalbuminemia, proteinuria, and absence of hematuria. He was diagnosed with nephrotic syndrome, and the administration of IFNβ-1b was stopped. Percutaneous renal biopsy was performed, and the histology revealed membranous nephropathy. A 33-year-old woman (case 2) with MS, who had been treated using IFNβ-1b for 7 years, was diagnosed with proteinuria during a medical checkup. She was referred to a nephrologist and was found to have hypoalbuminemia and proteinuria. A diagnosis of nephrotic syndrome was made, and IFNβ-1b therapy was stopped. The patient underwent percutaneous renal biopsy, and the histology revealed membranous nephropathy. Both patients were treated using intravenous methylprednisolone followed by oral prednisolone. Case 1 was administered ciclosporin orally, and his clinical symptoms and laboratory test results improved at first, but his laboratory test results subsequently showed recurrence of proteinuria. Case 2 was administered mizoribine orally, resulting in improvement in clinical symptoms and laboratory test results. Case 2 showed relapse of multiple sclerosis, but the symptoms were mild and were alleviated after steroid therapy. IFNβ therapy has several complications including nephropathy. Previously, several cases of nephrotic syndrome associated with IFNβ within 2 years of therapy were reported, but drug-induced nephropathy could appear after several years of the therapy as our cases. We should pay attention to nephrotic syndrome under using long-term IFNβ.
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Affiliation(s)
- Kensuke Ikeda
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry
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Tornes L, Delgado S, Garcia-Buitrago M, Ortega MR, Rammohan KW. Focal segmental glomerulosclerosis secondary to subcutaneous interferon β-1a treatment in a patient with multiple sclerosis. Mult Scler Relat Disord 2012; 1:148-51. [DOI: 10.1016/j.msard.2012.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 01/31/2012] [Accepted: 02/09/2012] [Indexed: 11/15/2022]
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Olea T, Díaz-Mancebo R, Picazo ML, Martínez-Ara J, Robles A, Selgas R. Thrombotic microangiopathy associated with use of interferon-beta. Int J Nephrol Renovasc Dis 2012; 5:97-100. [PMID: 22815645 PMCID: PMC3399315 DOI: 10.2147/ijnrd.s30194] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Interferon-beta is widely used for the treatment of relapsing multiple sclerosis. The drug is usually well tolerated, but autoimmune adverse effects, including kidney disease, have been reported. Only a few cases of hemolytic uremic syndrome-thrombotic microangiopathy associated interferon-alpha have been described so far, and even fewer with beta-interferon. We report a patient who developed thrombotic microangiopathy during treatment with interferon-beta and improved after discontinuation and steroid therapy. Complement cascade and antiphospholipid antibodies are investigated. The spectrum of renal diseases associated with interferon-beta treatment is also reviewed.
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Affiliation(s)
- Teresa Olea
- Department of Nephrology, Hospital Universitario La Paz, Madrid, Spain
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Aravindan A, Yong J, Killingsworth M, Suranyi M, Wong J. Minimal change disease with interferon-beta therapy for relapsing remitting multiple sclerosis. Clin Kidney J 2009. [DOI: 10.1093/ndtplus/sfp162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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7
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Kremenchutzky M, Morrow S, Rush C. The safety and efficacy of IFN-beta products for the treatment of multiple sclerosis. Expert Opin Drug Saf 2007; 6:279-88. [PMID: 17480177 DOI: 10.1517/14740338.6.3.279] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Multiple sclerosis, a chronic demyelinating disease of the CNS, is now a treatable disease. Phase III clinical trials of three recombinant IFN-beta products conducted in relapsing-remitting multiple sclerosis have shown, albeit modest, significant effects on relapses and short-term progression of disability, and a more substantial effect on MRI parameters. However, these effects do not correlate well with clinical disease activity or long-term disability. Overall, IFN-beta is safe and generally well tolerated, and reported adverse events were comparable between preparations. Systemic side effects can be effectively managed by dose escalation, use of an auto-injector and careful clinical monitoring.
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Affiliation(s)
- Marcelo Kremenchutzky
- University of Western Ontario, Department of Clinical Neurological Sciences, London Health Sciences Centre, Canada
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Kumasaka R, Nakamura N, Shirato K, Fujita T, Murakami R, Shimada M, Nakamura M, Osawa H, Yamabe H, Okumura K. Nephrotic syndrome associated with interferon-beta-1b therapy for multiple sclerosis. Clin Exp Nephrol 2006; 10:222-5. [PMID: 17009081 DOI: 10.1007/s10157-006-0424-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 05/10/2006] [Indexed: 11/28/2022]
Abstract
A 43-year-old woman with multiple sclerosis (MS) had nephrotic syndrome 21 months after starting treatment with interferon (IFN)-beta-1b (subcutaneous administration). She had taken no drug except for the IFN-beta-1b. Because nephrotic syndrome may be induced by IFN therapy, the IFN was stopped. Percutaneous renal biopsy revealed that she had minimal change nephrotic syndrome. As nephrotic-range proteinuria, hypoalbuminemia, and general edema were worsening even 2 weeks after cessation of the drug, oral corticosteroid therapy (prednisolone 40 mg/day) was started. The nephrotic syndrome was treated successfully with prednisolone. The dosage of prednisolone was tapered, without a relapse, and then the corticosteroid therapy was stopped. IFN-beta-1b therapy was then resumed, and the patient is in remission for both nephrotic syndrome and MS. Though proteinuria and nephrotic syndrome is a rare adverse effect of IFN-beta-1b therapy, physicians treating MS patients with this agent should pay careful attention to new clinical symptoms and laboratory findings.
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Affiliation(s)
- Ryuichiro Kumasaka
- The Second Department of Internal Medicine, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
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Auty A, Saleh A. Nephrotic syndrome in a multiple sclerosis patient treated with interferon beta 1a. Can J Neurol Sci 2005; 32:366-8. [PMID: 16225183 DOI: 10.1017/s0317167100004303] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Interferon beta has become standard therapy for reducing relapse frequency in relapsing/remitting Multiple Sclerosis (RRMS). Several different preparations are available including interferon beta 1a (Avonex, Rebif) and interferon beta 1b (Betaferon/Betaseron). For the most part these preparations have been considered safe. Recently there have been concerns relating to liver and now kidney toxicity. CASE REPORT We present a case of a 28-yr-old male who developed a severe case of nephrotic syndrome while being treated for relapsing/remitting Multiple Sclerosis (RRMS) with weekly injections of interferon beta 1a. SUBSEQUENT COURSE: The nephrosis resolved almost completely once the interferon was stopped and after immunosuppressive treatment. At its peak the daily protein loss was 35.82 g. Kidney biopsy demonstrated membranous glomerulonephritis. DISCUSSION Two other case reports of nephrotic syndrome have been reported in the literature. This latest (third) report suggests that the safety profile should be reexamined and at least raises the question of potential renal toxicity of interferons in MS.
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Affiliation(s)
- Anthony Auty
- Division of Neurology, Department of Medicine, Shaikh Khalifa Medical Centre, Abu Dhabi, United Arab Emirates
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Karie S, Launay-Vacher V, Izzedine H, Deray G. Néphrotoxicité des médicaments : veille bibliographique janvier 2003–décembre 2004. Nephrol Ther 2005; 1:285-95. [PMID: 16895697 DOI: 10.1016/j.nephro.2005.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Revised: 03/24/2005] [Accepted: 06/13/2005] [Indexed: 11/17/2022]
Abstract
Drug-induced kidney injury is a major side effect in clinical practice. Renal injury associated with drugs may involve several components of the kidney: glomerulus, tubules, interstitium and blood vessels. Acute renal failure may occur as a major reaction to many drugs. Moreover, therapeutic agents may induce an allergic reaction leading to interstitial inflammation and tubular damage. In this article, we present an updated version of the bibliography containing the case reports of nephrotoxicity published in the international literature from January 2003 to December 2004.
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Affiliation(s)
- Svetlana Karie
- Service de néphrologie, groupe hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75015 Paris, France.
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