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Reduced Tripartite Motif-Containing Protein 29 Deteriorates the Severity of Severe Acute Pancreatitis. Pancreas 2022; 51:469-475. [PMID: 35835099 DOI: 10.1097/mpa.0000000000002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Severe acute pancreatitis (SAP) is the most serious subtype of acute pancreatitis, manifested as multiple-organ failure resulting in high morbidity and mortality. Based on the role of tripartite motif-containing protein 29 (TRIM29) in immune responses, we aimed to explore its effect on SAP. METHODS Peripheral blood monocyte cells from the SAP or non-SAP patients, as well as bone marrow-derived macrophages from wild-type, TRIM29 -/- , or stimulator of interferon genes (STING) -/- mice after injecting 50 mg/kg of cerulein to induce SAP, were isolated to analyze the role of TRIM29 and STING in the SAP. RESULTS Tripartite motif-containing protein 29 was significantly reduced in SAP patients. Compared with wild-type mice, TRIM29 deficiency mice displayed more severe symptom of acute pancreatitis after cerulein injection, which were lost in TRIM29 -/- STING -/- mice. Moreover, interferon and its related genes, as well as STING degradation, were decreased in TRIM29 -/- mice. CONCLUSIONS Our study demonstrated that TRIM29 negatively regulated the severity of SAP by degrading STING at its downstream, suggesting that TRIM29 and STING might serve as therapeutic targets for SAP.
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Wolfe D, Kanji S, Yazdi F, Barbeau P, Rice D, Beck A, Butler C, Esmaeilisaraji L, Skidmore B, Moher D, Hutton B. Drug induced pancreatitis: A systematic review of case reports to determine potential drug associations. PLoS One 2020; 15:e0231883. [PMID: 32302358 PMCID: PMC7164626 DOI: 10.1371/journal.pone.0231883] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE A current assessment of case reports of possible drug-induced pancreatitis is needed. We systematically reviewed the case report literature to identify drugs with potential associations with acute pancreatitis and the burden of evidence supporting these associations. METHODS A protocol was developed a priori (PROSPERO CRD42017060473). We searched MEDLINE, Embase, the Cochrane Library, and additional sources to identify cases of drug-induced pancreatitis that met accepted diagnostic criteria of acute pancreatitis. Cases caused by multiple drugs or combination therapy were excluded. Established systematic review methods were used for screening and data extraction. A classification system for associated drugs was developed a priori based upon the number of cases, re-challenge, exclusion of non-drug causes of acute pancreatitis, and consistency of latency. RESULTS Seven-hundred and thirteen cases of potential drug-induced pancreatitis were identified, implicating 213 unique drugs. The evidence base was poor: exclusion of non-drug causes of acute pancreatitis was incomplete or poorly reported in all cases, 47% had at least one underlying condition predisposing to acute pancreatitis, and causality assessment was not conducted in 81%. Forty-five drugs (21%) were classified as having the highest level of evidence regarding their association with acute pancreatitis; causality was deemed to be probable or definite for 19 of these drugs (42%). Fifty-seven drugs (27%) had the lowest level of evidence regarding an association with acute pancreatitis, being implicated in single case reports, without exclusion of other causes of acute pancreatitis. DISCUSSION Much of the case report evidence upon which drug-induced pancreatitis associations are based is tenuous. A greater emphasis on exclusion of all non-drug causes of acute pancreatitis and on quality reporting would improve the evidence base. It should be recognized that reviews of case reports, are valuable scoping tools but have limited strength to establish drug-induced pancreatitis associations. REGISTRATION CRD42017060473.
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Affiliation(s)
- Dianna Wolfe
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Fatemeh Yazdi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pauline Barbeau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danielle Rice
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrew Beck
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Claire Butler
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Leila Esmaeilisaraji
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Haffar S, Kaur RJ, Garg SK, Hyder JA, Murad MH, Abu Dayyeh BK, Bazerbachi F. Acute pancreatitis associated with intravenous administration of propofol: evaluation of causality in a systematic review of the literature. Gastroenterol Rep (Oxf) 2018; 7:13-23. [PMID: 30792862 PMCID: PMC6375349 DOI: 10.1093/gastro/goy038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/04/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022] Open
Abstract
Acute pancreatitis (AP) associated with intravenous administration of propofol has been described with unknown causal relation. We therefore assessed this causality in a systematic review. Multiple databases were searched on 16 August 2017; studies were appraised and selected by two reviewers based on a priori criteria. Propofol causality was evaluated with the Naranjo scale and Badalov classification. We identified 18 studies from 11 countries with a total of 21 patients, and the majority had adequate methodological quality. The median age was 35 years (range, 4–77) and 10 (48%) were males. Overall, propofol was administrated in 8 patients as sedative along with induction/maintenance of anesthesia in 13 patients; median dose was 200 mg, with intermediate latency (1–30 days) in 14 (67%). Serum triglycerides were >1000 mg/dL in four patients. Severe AP was observed in four patients (19%). AP recurrence occurred in one out of two patients who underwent rechallenge. Mortality related to AP was 3/21(14%). Propofol was the probable cause of AP according to the Naranjo scale in 19 patients (89%). Propofol-induced AP has a probable causal relation and evidence supports Badalov class Ib. Hypertriglyceridemia is not the only mechanism by which propofol illicit AP. Propofol-induced AP was severe in 19% of patients with a mortality rate related to AP of 14%. Future research is needed to delineate whether this risk is higher if combined with other procedures that portend inherent risk of pancreatitis such as endoscopic retrograde cholangiopancreatography.
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Affiliation(s)
- Samir Haffar
- Digestive Center for Diagnosis & Treatment, 29 Ayar Street, Damascus, Syrian Arab Republic
| | - Ravinder Jeet Kaur
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Sushil Kumar Garg
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Joseph A Hyder
- Division of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - M Hassan Murad
- Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Systematic review of acute pancreatitis associated with interferon-α or pegylated interferon-α: Possible or definitive causation? Pancreatology 2018; 18:691-699. [PMID: 30061072 DOI: 10.1016/j.pan.2017.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/26/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acute pancreatitis (AP) associated with interferon-α or pegylated interferon-α (AP-IFN) has been described, although the causal relation certitude remains elusive. Some recent studies suggest definite causality, although the relation is grouped in class III of Badalov classification of drug-induced AP. OBJECTIVES Perform systematic review of AP-IFN and assess causality. METHODS Two reviewers independently evaluated the data and quality of studies extracted from multiple databases on March 13, 2017. Studies selection was based on a priori criteria. Naranjo scale, and Badalov classification were applied to determine causality. RESULTS We identified 16 studies that reported AP-IFN with a total of 23 patients. Fifteen studies had moderate to good methodological quality. The frequency of AP-IFN was 7/3450 (0.2%). The median age of patients was 50 years. In most cases IFN was used for chronic hepatitis C. The latency between IFN and diagnosis of AP was (>30 days). AP was mild or moderately severe and improved with supportive management. No mortality was observed. Re-challenge was done in 5 patients and resulted in AP recurrence in 3 cases. Twenty-one cases were classified as probable and 2 cases as definitive according to Naranjo scale. Evaluations of studies confirm a status Ia for AP-IFN according to Badalov classification. CONCLUSION AP-IFN is rare and has a probable or definite causal relation according to Naranjo scale. The evidence supports a class Ia of Badalov classification. Hypertriglyceridemia is not a contributing factor. IFN-induced AP is usually mild or moderately severe, and responds favorably to supportive management.
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Lin HF, Liao KF, Chang CM, Lin CL, Lai SW. Association of use of selective serotonin reuptake inhibitors with risk of acute pancreatitis: a case-control study in Taiwan. Eur J Clin Pharmacol 2017; 73:1615-1621. [PMID: 28856398 DOI: 10.1007/s00228-017-2328-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Few studies have reported the association of the use of selective serotonin reuptake inhibitors (SSRIs) with acute pancreatitis. We conducted a population-based case-control study to explore this relationship. METHODS In this study, 4631 cases with first attack of acute pancreatitis and 4631 controls without acute pancreatitis were selected using a randomly sampled cohort of one million health insurance enrollees from 2000 to 2013. Both cases and controls were aged 20-84 years and were matched with sex, age, comorbidities, and index year of diagnosis of acute pancreatitis. Patients with current use of SSRIs were defined as those whose last tablet of SSRIs was noted ≤ 7 days before the date of diagnosis of acute pancreatitis; patients with late use of SSRIs were defined as those whose last tablet of SSRIs was noted ≥ 8 days before the date of diagnosis; and patients with no use of SSRIs were defined as those who were never prescribed SSRIs. The odds ratio (OR) and 95% confidence interval (CI) for acute pancreatitis associated with the use of SSRIs were assessed using multivariate unconditional logistic regression analysis. RESULTS After adjusting for covariables, multivariate logistic regression analysis revealed that compared with patients with no use of SSRIs, the adjusted OR of acute pancreatitis for those with current use of SSRIs was 1.7 (95% CI, 1.1-2.5), whereas that for patients with late use of SSRIs was 1.0 (95% CI, 0.9-1.2) without statistical significance. CONCLUSIONS Current use of SSRIs is associated with the diagnosis of acute pancreatitis. Therefore, clinicians should consider the possibility of SSRI-associated acute pancreatitis among patients currently taking SSRIs and those presenting with the diagnosis of acute pancreatitis without a definite cause.
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Affiliation(s)
- Hsien-Feng Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, No 2, Yuh-Der Road, Taichung City, 404, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Mei Chang
- Department of Nursing, Tungs' Taichung Metro Habor Hospital, Taichung, 435, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- Department of Family Medicine, China Medical University Hospital, No 2, Yuh-Der Road, Taichung City, 404, Taiwan. .,College of Medicine, China Medical University, Taichung, Taiwan.
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Chang CC, Chiou CS, Lin HL, Wang LH, Chang YS, Lin HC. Increased Risk of Acute Pancreatitis in Patients with Rheumatoid Arthritis: A Population-Based Cohort Study. PLoS One 2015; 10:e0135187. [PMID: 26262880 PMCID: PMC4532490 DOI: 10.1371/journal.pone.0135187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/18/2015] [Indexed: 12/24/2022] Open
Abstract
The study was conducted to determine whether patients with rheumatoid arthritis (RA) are at increased risk of acute pancreatitis compared with those without RA and to determine if the risk of acute pancreatitis varied by anti-RA drug use. We used the large population-based dataset from the National Health Insurance (NHI) program in Taiwan to conduct a retrospective cohort study. Patients newly diagnosed with RA between 2000 and 2011 were referred to as the RA group. The comparator non-RA group was matched with propensity score, using age and sex, in the same time period. We presented the incidence density by 100,000 person-years. The propensity score and all variables were analyzed in fully adjusted Cox proportional hazard regression. The cumulative incidence of acute pancreatitis was assessed by Kaplan-Meier analysis, with significance based on the log-rank test. From claims data of one million enrollees randomly sampled from the Taiwan NHI database, 29,755 adults with RA were identified and 119,020 non- RA persons were matched as a comparison group. The RA cohort had higher incidence density of acute pancreatitis (185.7 versus 119.0 per 100,000 person-years) than the non-RA cohort. The adjusted hazard ratio (HR) was 1.62 (95% CI [confidence interval] 1.43–1.83) for patients with RA to develop acute pancreatitis. Oral corticosteroid use decreased the risk of acute pancreatitis (adjusted HR 0.83, 95% CI 0.73–0.94) but without a dose-dependent effect. Current use of disease modifying anti-rheumatic drugs or tumor necrosis factor blockers did not decrease the risk of acute pancreatitis. In conclusion, patients with RA are at an elevated risk of acute pancreatitis. Use of oral corticosteroids may reduce the risk of acute pancreatitis.
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Affiliation(s)
- Chi Ching Chang
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chi Sheng Chiou
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiu Li Lin
- Department of Neurology, General Cathay Hospital, Sijhih Branch, New Taipei City, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Li Hsuan Wang
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
- Department of Pharmacy, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hsiu-Chen Lin
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Laboratory Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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7
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Douros A, Bronder E, Andersohn F, Klimpel A, Thomae M, Ockenga J, Kreutz R, Garbe E. Drug-induced acute pancreatitis: results from the hospital-based Berlin case-control surveillance study of 102 cases. Aliment Pharmacol Ther 2013; 38:825-34. [PMID: 23957710 DOI: 10.1111/apt.12461] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/03/2013] [Accepted: 07/31/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Drug toxicity is a well-known cause of acute pancreatitis (AP). Although many drugs have been associated with AP, the magnitude of the risk of most of them remains largely unknown. AIM To determine the pancreatotoxic risk of a wide range of drugs. METHODS The hospital-based Berlin case-control surveillance study, including all 51 Berlin hospitals in a hospital network, ascertained 102 cases with idiopathic AP (IAP) and 750 controls between 2002 and 2011. Patients with IAP were thoroughly validated using anamnestic, clinical or laboratory data. Drug exposure was obtained in a face-to-face interview. Possible drug aetiology was assessed in individual patients through a standardised causality assessment applying the criteria of the World Health Organization. Drug risks were further quantified [odds ratios (OR) with 95% confidence intervals (CI)] in a case-control design with unconditional logistic regression analysis. RESULTS The pancreatotoxic risk of several drugs, including azathioprine (OR 5.1; 95% CI 1.9-13.5), fenofibrate (OR 12.2; 95% CI 2.3-69.1), mesalazine (OR 3.3; 95% CI 1.1-9.5) or angiotensin-converting enzyme inhibitors, was corroborated by case-control analysis and causality assessment. Causality assessment suggested a pancreatotoxic potential, among others, for mercaptopurine or the seldom reported leflunomide, and alluded to a novel risk for tocilizumab. Case-control analysis showed an increased risk for two phytotherapeutics: harpagophytum and valerian radix. CONCLUSIONS Our study quantified the pancreatotoxic risk of different drugs and phytotherapeutics. The findings corroborate previous results from the literature but also indicate risks for substances not previously reported, highlighting the need for further controlled studies on pancreatic toxicity.
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Affiliation(s)
- A Douros
- Department of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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8
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Risk of acute pancreatitis in type 2 diabetes and risk reduction on anti-diabetic drugs: a population-based cohort study in Taiwan. Am J Gastroenterol 2011; 106:1697-704. [PMID: 21577242 DOI: 10.1038/ajg.2011.155] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The objective of this study was to assess the risk of acute pancreatitis among patients with type 2 diabetes mellitus (DM) and identify the roles of co-morbidities and anti-diabetic drugs. METHODS From claims data of one million enrollees randomly sampled from a population covered by the Taiwan National Health Insurance, 19,518 adults with type 2 DM diagnosed between 2000 and 2005 were identified. In addition, 78,072 DM-free persons, frequency matched with sex, age, and index year for comparison were identified. Subjects were followed up until the end of 2008 or censored to ascertain incident acute pancreatitis cases and associations with co-morbidities and anti-diabetic drugs. RESULTS Patients with type 2 DM had 1.95-fold greater incidence of acute pancreatitis compared with non-diabetics (27.7 vs. 14.2 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.89 (95% confidence interval (CI)=1.65-2.18) based on multivariable Cox regression analysis. Additive Poisson regression analysis revealed an absolute risk increase of 14.4 per 10,000 person-years (95% CI=13.4-15.5) among type 2 DM patients. Co-morbid alcoholism, hepatitis C infection, and gallstones yielded additional risk of acute pancreatitis among type 2 DM patients (absolute risk increase ranges 86.3, 41.1, and 23.5 per 10,000 person-years, respectively). Patients taking anti-diabetic drugs had a reduced risk of acute pancreatitis, however. The adjusted HR decreased to 0.31 (95% CI=0.18-0.56) among patients who took five different anti-diabetic drugs. CONCLUSIONS Patients with type 2 DM are at an elevated risk of acute pancreatitis. Alcoholism, hepatitis C infection, and gallstones increase the risk further. However, anti-diabetic drugs reduce the risk as the number of drugs used increases and as the duration of treatment increases.
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Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, Goldberg AC, Howard WJ, Jacobson MS, Kris-Etherton PM, Lennie TA, Levi M, Mazzone T, Pennathur S. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2292-333. [PMID: 21502576 DOI: 10.1161/cir.0b013e3182160726] [Citation(s) in RCA: 1245] [Impact Index Per Article: 95.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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10
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Ando K, Kim SR, Imoto S, Nakajima T, Mita K, Fukuda K, Taniguchi M, Sasase N, Muramatsu A, Matsuoka T, Kudo M, Hayashi Y. Acute Pancreatitis Associated with Pegylated Interferon and Ribavirin Treatment of Chronic Hepatitis C, Genotype 1b with High Viral Load. Case Rep Gastroenterol 2009; 3:372-376. [PMID: 21103256 PMCID: PMC2988932 DOI: 10.1159/000256557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Acute pancreatitis, an uncommon side effect of pegylated interferon α (PEG-IFN α) and ribavirin (RBV) combination therapy, has rarely been reported in the English language literature. Here, acute pancreatitis associated with PEG-IFN plus RBV treatment is described in three patients with chronic hepatitis C, genotype 1b with high serum hepatitis C virus RNA levels. The patients had been started on weekly subcutaneous injections of PEG-IFN α (60, 80, and 90 μg) plus a daily oral dose of RBV (600 mg). The therapy was discontinued, however, because of the onset of acute pancreatitis (after 15 weeks, 48 weeks, and 3 weeks respectively). The drug-induced pancreatitis was diagnosed on the basis of elevated levels of amylase and lipase and the absence of other identifiable causes. High tumor necrosis factor-α was found in one patient and high interleukin-6 in the other two. The immune system stimulated by PEG-IFN and RBV combination therapy might have caused the acute pancreatitis. Further study is needed to clarify the mechanism of the onset of drug-induced pancreatitis by PEG-IFN and RBV combination therapy.
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Affiliation(s)
- Kenji Ando
- Department of Gastroenterology, Kobe Asahi Hospital, Kobe, Japan
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da Silva J, Giroldi SB, de Oliveira Basso F, Antunes GN, Borba LA, de Lima CRM. Acute pancreatitis during interferon-alpha and ribavirin treatment for hepatitis C. BMJ Case Rep 2009; 2009:bcr09.2008.0998. [PMID: 21686514 PMCID: PMC3029912 DOI: 10.1136/bcr.09.2008.0998] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A patient treated with interferon-alpha and ribavirin for hepatitis C, who developed acute pancreatitis, is presented here along with a literature review. A 45-year-old Caucasian man was admitted to the intensive care unit because of an acute pancreatitis. According to the adverse drug reaction probability scale, it is probable that pancreatitis was induced by treatment (interferon and ribavirin) for chronic hepatitis C (CHC) commenced 2 months ago. We performed a literature search of all available English-language articles published on MEDLINE between January 1966 and July 2008 using the key terms "acute pancreatitis", "interferon" and "ribavirin"; only four papers were found with a total of 13 reported cases demonstrating acute pancreatitis developed during treatment for CHC. Looking out for the minimal clinical signs and symptoms of acute pancreatitis in patients with CHC using interferon and ribavirin can help to detect this relevant and rare adverse drug reaction early.
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Affiliation(s)
- Jane da Silva
- UNISUL - Universidade do Sul de Santa Catarina, Medicine, Av Pedra Branca, 25, Cidade Universitária Pedra Branca, Palhoça, 88132-000, Brazil
| | - Simone Batisti Giroldi
- Universidade do Extremo Sul Catarinense, Medicine, Av Universitária, 1105, Criciuma, Santa Catarina, 88806-000, Brazil
| | - Franciani de Oliveira Basso
- Complexo Hospitalar Santa Casa de Porto Alegre, Rua: Prof. Annes Dias, 295, Porto Alegre, Rio Grande do Sul, 90020-090, Brazil
| | - Georgia Nunes Antunes
- Hospital São José, Rua Cel. Pedro Benedet, 630, Cx.P. 63, Criciuma, Santa Catarina, 88801-250, Brazil
| | - Luis Augusto Borba
- Hospital São José, Rua Cel. Pedro Benedet, 630, Cx.P. 63, Criciuma, Santa Catarina, 88801-250, Brazil
| | - Cássio Renato Montenegro de Lima
- UNISUL - Universidade do Sul de Santa Catarina, Medicine, Av Pedra Branca, 25, Cidade Universitária Pedra Branca, Palhoça, 88132-000, Brazil
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Abstract
Cardiovascular toxicity is an important adverse effect of several classes of oncology drugs. Because cancer survivors are living longer, the late effects of cancer therapy must be addressed. Many patients diagnosed with cancer are already at an increased risk for cardiovascular disease before drug treatment. Select chemotherapy agents further complicate the issue because of their own ability to induce cardiovascular toxicities or exacerbate preexisting conditions. Hypertension, dyslipidemia, heart failure, and arrhythmia are known consequences of some cancer therapies. This review provides an overview of the epidemiology, mechanism of action, monitoring, and management of these cardiovascular effects.
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Affiliation(s)
- Bradi L. Frei
- University of the Incarnate Word, Feik School of Pharmacy, Department of Pharmacy Practice, frei@ uiwtx.edu
| | - Scott A. Soefje
- Cancer Therapy and Research Center, The University of Texas Health Science Center at San Antonio San Antonio, Texas
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Affiliation(s)
- Anil R Balani
- Division of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, New York 11501, USA
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Badalov N, Baradarian R, Iswara K, Li J, Steinberg W, Tenner S. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol 2007; 5:648-61; quiz 644. [PMID: 17395548 DOI: 10.1016/j.cgh.2006.11.023] [Citation(s) in RCA: 344] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The diagnosis of drug-induced acute pancreatitis often is difficult to establish. Although some medications have been shown to cause acute pancreatitis with a large body of evidence, including rechallenge, some medications have been attributed as a cause of acute pancreatitis merely by a single published case report in which the investigators found no other cause. In addition, some medications reported to have caused acute pancreatitis have obvious patterns of presentation, including the time from initiation to the development of disease (latency). There also appear to be patterns in the severity of disease. After reviewing the literature, we have classified drugs that have been reported to cause acute pancreatitis based on the published weight of evidence for each agent and the pattern of clinical presentation. Based on our analysis of the level of evidence, 4 classes of drugs could be identified. Class I drugs include medications in which at least 1 case report described a recurrence of acute pancreatitis with a rechallenge with the drug. Class II drugs include drugs in which there is a consistent latency in 75% or more of the reported cases. Class III drugs include drugs that had 2 or more case reports published, but neither a rechallenge nor a consistent latency period. Class IV drugs were similar to class III drugs, but only 1 case report had been published. Our analysis allows an evidence-based approach when suspecting a drug as causing acute pancreatitis.
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Affiliation(s)
- Nison Badalov
- Division of Gastroenterology, Maimonides Medical Center, Mount Sinai School of Medicine, Brooklyn, New York 11235, USA
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15
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Yadav D, Eigenbrodt ML, Briggs MJ, Williams DK, Wiseman EJ. Pancreatitis: prevalence and risk factors among male veterans in a detoxification program. Pancreas 2007; 34:390-8. [PMID: 17446836 DOI: 10.1097/mpa.0b013e318040b332] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the prevalence of pancreatitis and associated risk factors among heavy-drinking veterans. METHODS At a large Veterans Administration Outpatient Detoxification Program (ODP) that systematically collects risk information, 1409 black and white male veterans with International Classification of Diseases, Ninth Revision codes for alcohol abuse enrolling in the ODP from January 2002 to December 2003 were identified. Among these patients, pancreatitis at any time (before the ODP admission or occurring through June 2005) was identified using International Classification of Diseases, Ninth Revision codes. Cases were verified by chart review. Logistic regression analyses were used for multivariable analyses. RESULTS Overall, history of smoking (89.6%) and current or past drug use (90.1%) were very common, whereas intravenous drug use (22.3%) was less so. Although 87 (6.2%) subjects had pancreatitis codes (acute, 50; chronic, 15; both, 22), chart review verified only 42 cases (acute, 29; chronic, 5; both, 8) for a 3% prevalence. Alcohol appeared to be the definite etiology in 39 of these 42 patients. In bivariate analyses, patients with pancreatitis were older, had more substance abuse admissions, reported a significantly heavier current alcohol use, and lower drug dependence (each P < 0.05). In multivariable models, alcoholic pancreatitis was associated positively with age (odds ratio, 1.08; 95% confidence interval, 1.04-1.12) and number of substance abuse admissions (odds ratio, 1.08; 95% confidence interval, 0.995-1.18; P = 0.06). CONCLUSIONS In this high-risk population of heavy drinkers, the prevalence of pancreatitis is at least 3%. Our study provides preliminary data regarding potential cofactors for pancreatitis in heavy drinkers.
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Affiliation(s)
- Dhiraj Yadav
- Division of Gastroenterology and Hepatology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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17
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Abstract
More and more HIV-infected patients are treated for viral hepatitis, increasing interactions. HEPATITIS C: The concomitant use of didanosine and ribavirin increases the risk of mitochondrial toxicity, responsible for pancreatitis and/or lactic acidosis. Lactic acidosis is characterized by a high mortality rate. Thus, didanosine, but also stavudine, should not be co-administered with ribavirin. Cases of hepatic decompensation have been reported in cirrhotics concomitantly receiving ribavirin and didanosine. Thus, this co-admininistration should be contraindicated in patients with advanced liver fibrosis. Anemia is a frequent side effect of ribavirin. In patients with zidovudine-related anemia, this drug should be discontinued before prescribing ribavirin. Erythropoietin may help to improve the haemoglobin level. HEPATITIS B: Adefovir significantly decreases the plasma levels of saquinavir. Pancreatitis may occur with the co-administration of didanosine and tenofovir. Thus this co-administration should be avoided. Atazanavir concentrations are decreased when tenofovir is co-administered. Thus, atazanavir should be boosted with ritonavir, when combined with tenofovir. Atazanavir increases the concentrations of tenofovir, with the potential risk of increasing the adverse events of tenofovir, including renal disorders. Tenofovir area under the curve is increased if lopinavir-ritonavir are co-administered. The main interactions, with a fatal risk, are observed with didanosine, when co-administered with ribavirin (hepatitis C) or with tenofovir (hepatitis B). Anemia is frequent, but usually moderate, when zidovudine is co-administered with ribavirin. Other interactions are usually easy to manage.
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Affiliation(s)
- Christian Perronne
- Unité des Maladies Infectieuses et Tropicales, Hôpital Universitaire Raymond Poincaré, Université de Versailles-Saint Quentin, 92380 Garches, France.
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Abstract
BACKGROUND AND AIMS Many frequently prescribed drugs are suspected to cause acute pancreatitis (AP). The goal of this paper is to bring to light the often occult but real problem of drug-induced pancreatitis (DIP). METHODS We searched the National Library of Medicine/Pubmed for reported cases of DIP from 1966 to April 30, 2004. Medications implicated in AP are classified based on the strength of evidence into one of three classes of drugs associated with pancreatitis. We reviewed the top 100 prescription medications in the United States for their association with AP. RESULTS Class I medications (medications implicated in greater than 20 reported cases of acute pancreatitis with at least one documented case following reexposure): didanosine, asparaginase, azathioprine, valproic acid, pentavalent antimonials, pentamidine, mercaptopurine, mesalamine, estrogen preparations, opiates, tetracycline, cytarabine, steroids, trimethoprim/sulfamethoxazole, sulfasalazine, furosemide, and sulindac. Class II medications (medications implicated in more than 10 cases of acute pancreatitis): rifampin, lamivudine, octreotide, carbamazepine, acetaminophen, phenformin, interferon alfa-2b, enalapril, hydrochlorothiazide, cisplatin, erythromycin, and cyclopenthiazide. Class III medications (all medications reported to be associated with pancreatitis). Of the top 100 most frequently prescribed medications in the United States, 44 have been implicated in AP, 14 of them fall into either Class I or II of medications associated with AP. CONCLUSIONS Among adverse drug reactions, pancreatitis is often-ignored because of the difficulty in implicating a drug as its cause. The physician should have a high index of suspicion for DIP, especially in specific subpopulations such as geriatric patients who may be on multiple medications, HIV+ patients, cancer patients, and patients receiving immunomodulating agents.
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Affiliation(s)
- Chirag D Trivedi
- Department of Medicine, Robert Wood Johnson Medical School, and Division of Gastroenterology, Hepatology and Clinical Nutrition, St. Peter's University Hospital, New Brunswick, NJ 08901, USA
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Cecchi E, Forte P, Cini E, Banchelli G, Ferlito C, Mugelli A. Pancreatitis induced by pegylated interferon alfa-2b in a patient affected by chronic hepatitis C. Emerg Med Australas 2004; 16:473-5. [PMID: 15537413 DOI: 10.1111/j.1742-6723.2004.00653.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A middle-aged man was admitted to the ED because of nausea and vomiting, abdominal distention and fainting. A blood analysis revealed high levels of serum amylase and lipase, confirming a diagnosis of acute pancreatitis. The history showed that the patient had self-administered a single dose of pegylated interferon alfa-2b and ribavirin daily for 7 days for chronic hepatitis C. The medications were stopped and his condition gradually improved. In agreement with the literature and the Naranjo algorythm result, pegylated interferon alfa-2b is associated with acute pancreatitis. Identification of a few signs and symptoms is the first 'signal' in preventing a serious drug-induced adverse event.
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Affiliation(s)
- Enrica Cecchi
- Department of Pharmacology, University of Florence, Florence, Italy.
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Wong SF, Jakowatz JG, Taheri R. Management of Hypertriglyceridemia in Patients Receiving Interferon for Malignant Melanoma. Ann Pharmacother 2004; 38:1655-9. [PMID: 15304625 DOI: 10.1345/aph.1d546] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe 3 cases of hypertriglyceridemia associated with the use of interferon alfa (IFN-α) for the treatment of malignant melanoma and propose a management plan for dyslipidemia associated with interferon therapy CASE SUMMARIES Three case reports of hypertriglyceridemia with or without elevation of total cholesterol level associated with the use of adjuvant IFN-α for the treatment of malignant melanoma are described. These patients received IFN-α-based adjuvant therapy with doses ranging from 5–20 million units/m 2 for 1–2 years' duration. The onset and severity of dyslipidemia appeared to occur randomly. Pre-existing cardiovascular disorders did not seem to play a role. The patients were treated with atorvastatin, gemfibrozil, and a combination of lovastatin with niacin, depending on their lipid panel results. DISCUSSION Based on our case reports and published data, hypertriglyceridemia is more frequently associated with longer duration of interferon therapy, although the time of onset is not clearly defined. Presence or absence of baseline dyslipidemia does not seem to play a role in the development of hypertriglyceridemia associated with interferon, and its occurrence and severity are not dependent on the dose. Lifestyle modifications should be encouraged in patients who develop dyslipidemia, and drug treatment should be considered. If drug therapy is indicated, fibric acid derivatives should be considered as first-line therapy. Even at lower doses, this class of drug seems to be effective in managing severe triglyceride elevations in these patients. The Naranjo probability scale of these cases ranged from possible to probable. CONCLUSIONS Hypertriglyceridemia is a rare but potentially severe adverse consequence of interferon therapy. Patients with malignant melanoma who develop dyslipidemia while receiving interferon should be considered for antidyslipidemic management.
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Affiliation(s)
- Siu-Fun Wong
- Western University College of Pharmacy, Pomona, CA, USA.
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Daugherty AL, Mrsny RJ. Emerging technologies that overcome biological barriers for therapeutic protein delivery. Expert Opin Biol Ther 2004; 3:1071-81. [PMID: 14519072 DOI: 10.1517/14712598.3.7.1071] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the past decade, genomic research and the nascent field of proteomics have exponentially increased the number of potential protein therapeutic molecules for treating medical needs that were previously unmet. To realise the full clinical potential of many of the novel protein drug entities arising from these intense research efforts, emerging protein delivery technologies may be required. Advanced delivery technologies may offer the ability to overcome biochemical and anatomical barriers to protein drug transport, without incurring adverse events, to deliver the agent(s) at a certain desired rate and duration, to protect therapeutic macromolecules from in situ or systemic degradation, as well as increase their therapeutic index by targeting the drug action to a specific site. This review will cover a myriad of novel and emerging technologies that are directed at bypassing biological barriers and that have shown promise in advancing the therapeutic potential of protein drugs.
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Affiliation(s)
- Ann L Daugherty
- Department of Pharmaceutical Research and Development, Genentech, Inc., South San Francisco, CA 94080, USA
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Resnick D, Krinsky GA, Lavelle MT, Lee VS, Keogan MT, Morrin MM. Do patients with primary sclerosing cholangitis have a greater frequency of pancreatic abnormalities at MRI than patients with other liver diseases? J Comput Assist Tomogr 2002; 26:994-9. [PMID: 12488749 DOI: 10.1097/00004728-200211000-00024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE It has been proposed that there is an increased frequency of pancreatic abnormalities in patients with primary sclerosing cholangitis (PSC). Our purpose is to compare the frequency of pancreatic abnormalities detected at MRI in patients with PSC and to compare these findings with those found in a matched cohort with other liver diseases. METHOD We identified 29 patients who had either a histologic or an endoscopic retrograde cholangiopancreatography diagnosis of PSC and 29 age- and gender-matched patients with liver disease without PSC who underwent MRI at 1.5 T. The protocol included breath-hold T1-weighted gradient echo, echo train, fast spin echo, T2-weighted images and dynamic gadolinium-enhanced MRI. Two blinded readers retrospectively evaluated the MR images for abnormalities of pancreatic size and morphology, T1 and T2 signal intensity, duct size and irregularities, arterial-phase contrast enhancement, focal pancreatic masses, cystic lesions, peripancreatic fluid/edema, ascites, and capsular-like rim surrounding the pancreas. RESULTS The prevalence of pancreatic and peripancreatic abnormalities was 10 of 29 (35%) in PSC patients and 14 of 29 (48%) in control patients. MR findings included ascites (9 PSC, 12 controls), peripancreatic edema (7 PSC, 11 controls), atrophy (4 PSC, 3 control), increased T2 signal (3 PSC, 4 controls), cystic lesions (2 PSC, 3 controls), abnormal T1 signal (1 PSC, 2 controls), and dilated pancreatic ducts (3 PSC, 2 controls). Quantitative parameters were not significantly different between PSC patients and the control subjects with pancreatic findings. CONCLUSION There is no significant difference in pancreatic abnormalities detected on MRI between patients with PSC and those with other liver diseases.
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Affiliation(s)
- Daniel Resnick
- Department of Radiology, NYU Medical Center, 530 First Avenue, Basement HCC, New York, NY 10016, USA
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Kirkwood JM, Bender C, Agarwala S, Tarhini A, Shipe-Spotloe J, Smelko B, Donnelly S, Stover L. Mechanisms and management of toxicities associated with high-dose interferon alfa-2b therapy. J Clin Oncol 2002; 20:3703-18. [PMID: 12202672 DOI: 10.1200/jco.2002.03.052] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The toxicity associated with adjuvant high-dose interferon-alfa-2b therapy (HDI) for high-risk melanoma can lead to premature discontinuation. It is important to understand the expected adverse events and their underlying mechanisms and to anticipate and aggressively manage toxicity during treatment in order to ensure that patients receive the maximum therapeutic benefit. METHODS The toxicity profile of HDI was reviewed by examining data from the United States cooperative group trials. Available published data related to the potential mechanisms responsible for the observed adverse events are discussed, and comprehensive recommendations for managing side effects are presented. RESULTS The HDI regimen is associated with acute constitutional symptoms, chronic fatigue, myelosuppression, elevated liver enzyme levels, and neurologic symptoms. The majority of patients tolerate 1 year of therapy with an understanding of the anticipated toxicities in conjunction with appropriate dose modifications and supportive care. Ongoing monitoring for liver dysfunction and hematologic toxicity is critical to ensure safety. Many of the toxicities associated with interferon-alfa (IFN-alpha) seem to be the result of endogenous cytokines and their effects on the neuroendocrine system. Recent data have also demonstrated that IFN-alpha suppresses the activity of specific CYP450 isoenzymes and that this correlates with discrete toxicities. Pharmacologic interventions are under study for fatigue and depression. An increased understanding of the mechanisms of IFN-alpha-associated toxicity will lead to more rational and effective supportive care and improved quality of life. CONCLUSION Continued research in this area should lead to improvements in the safety and tolerability of adjuvant therapy for melanoma.
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Affiliation(s)
- John M Kirkwood
- University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Kumar KS, Russo MW, Borczuk AC, Brown M, Esposito SP, Lobritto SJ, Jacobson IM, Brown RS. Significant pulmonary toxicity associated with interferon and ribavirin therapy for hepatitis C. Am J Gastroenterol 2002; 97:2432-40. [PMID: 12358269 DOI: 10.1111/j.1572-0241.2002.05999.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the clinical presentation and outcomes of significant pulmonary toxicity associated with interferon and ribavirin. METHODS We conducted a retrospective review of patients enrolled in four clinical trials at three sites, two academic medical centers and one community practice, and reviewed the literature. RESULTS Four patients, while on therapy with interferon a and ribavirin for chronic hepatitis C, developed significant pulmonary signs and symptoms. Further workup, which included lung biopsy in three, revealed bronchiolitis obliterans organizing pneumonia in two, and interstitial pneumonitis in two other cases. There were no other predisposing factors for lung disease identified. Resolution of symptoms occurred in all patients upon discontinuation of interferon and ribavirin, with or without corticosteroid therapy. One of the patients developed pulmonary complications while on a clinical trial of pegylated interferon and represents the first reported case associated with the use of long-acting interferon in chronic hepatitis C infection. CONCLUSIONS A spectrum of significant pulmonary toxicity, including bronchiolitis obliterans organizing pneumonia and interstitial pneumonitis, can occur with interferon or pegylated interferon in combination with ribavirin. Though pulmonary toxicity of interferon is well known, these cases represent the first cases reported in the literature with combination therapy. It is likely that pulmonary toxicity may not be investigated in patients on combination therapy because of the frequent pulmonary symptoms with ribavirin. Though usually reversible, at least one case has required long-term steroids with inadequate resolution. Though pulmonary toxicity is rare, symptoms which are more than mild or progressive in nature should likely be investigated.
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Affiliation(s)
- K Shiva Kumar
- Center for Liver Disease and Transplantation, New York-Presbyterian Hospital, New York, USA
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