Membranous nephropathy induced by pegylated interferon alpha-2a therapy for chronic viral hepatitis B

Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Clinical nephrology (Impact Factor: 1.13). 06/2012; 77(6):496-500. DOI: 10.5414/CN106903
Source: PubMed


Interferon is used to treat chronic viral hepatitis because of low drug resistance and a high remission rate. However, its propensity to induce and modify autoimmunity has been reported. We used pegylated interferon α-2a to treat a patient with chronic viral hepatitis B. After 5 months of this therapy, the patient developed membranous nephropathy. Complete remission of his nephrotic syndrome was achieved after 1 year of cyclosporine and corticosteroid therapy. During this same period, his chronic viral hepatitis B was controlled by entecavir. To our knowledge, this is the first case in which membranous nephropathy developed during pegylated interferon α-2a therapy for chronic hepatitis B. The autoimmune modulation induced by interferon is the most likely mechanism for this complication.

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    • "Consistent with these effects, an increased prevalence of autoimmune disease is observed when interferon is used to treat diseases like hepatitis B, hepatitis C, or multiple sclerosis . Reports observe that interferon therapy is associated with an increase in autoimmune thyroid disease, type 1 diabetes, membranous nephropathy, and other self-antigeninduced diseases (Mammen et al. 2012; Radhakrishnan et al. 2005; Scavone et al. 2010; Tosone et al. 2007; Tsai et al. 2012). Therapeutically, one would predict that raising the stress response might mitigate the autoimmune destruction of the beta cell. "
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    ABSTRACT: HCV infects approximately 2-3 % of the global population and is a leading cause of end-stage liver disease and hepatocellular carcinoma. Antiviral treatment with pegylated interferon and ribavirin eradicates HCV in many patients, while 40-90 % of patients on pegylated IFN plus ribavirin have sustained viral clearance [1]. However, IFNbased therapy is limited by frequent and, at times, serious adverse effects which represent an important barrier to treatment delivery. In clinical trials, approximately 10-15 % of patients discontinue peg-IFN and ribavirin therapy due to adverse effects, but, in clinical practice, the rate of treatment interruption is probably higher. Combined antiviral therapy (conventional or pegylated IFN plus ribavirin) impacts most, if not all, organ systems. According to the KULDS Group, the rate of treatment discontinuation was 8.7 % (n = 250) in a total of 2,871 Japanese patients who had chronic HCV treated with peg- IFN a-2b and RBV [1].
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