Peginterferon-α/ribavirin/telaprevir
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Reactions 1502, p31 - 24 May 2014 S Peginterferon-α/ribavirin/telaprevir Thrombotic microangiopathy: case report A 53-year-old woman developed thrombotic microangiopathy while receiving peginterferon-α, ribavirin and telaprevir for hepatitis C. The woman presented to an emergency department after having collapsed in the hepatology outpatient unit. She had been receiving triple hepatitis C treatment comprising ribavirin 600mg twice daily, telaprevir 750mg three times daily [routes not stated] and SC peginterferon-α 180µg weekly, for 12 weeks prior to admission. She reported a 1-week history of nausea, vomiting and fatigue, and was observed to have a diffuse maculopapular rash on her trunk and limbs. Tests showed elevated creatinine and lactate dehydrogenase levels, with low haemoglobin and platelet levels. A urinalysis was positive for protein and blood. Undetectable haptoglobins and red cell fragments were evident on blood film. A renal biopsy showed microthrombi and fragments in the small vessels and glomeruli. She was diagnosed with thrombotic microangiopathy, which was thought to be caused by her hepatitis C treatment. The woman’s antiviral treatment was stopped, and she was given seven sessions of plasma exchange. Her acute kidney injury subsequently resolved, and her platelet count normalised. Author comment: "[T]his is the first description of [thrombotic microangiopathy] complicating triple therapy. Telaprevir is an inhibitor of the hepatitis C NS3/4A serine protease, which is required for viral replication. Interferon and ribavirin may induce [thrombotic microangiopathy] through an immunomodulatory effect." Evans R, et al. Thrombotic microangiopathy (TMA) in a patient treated with antiviral therapy for hepatitis C. BMJ Case Reports : No. 203290, 4 Apr 2014. Available from: URL: http://doi.org/10.1136/bcr-2013-203290 - United Kingdom 803103608 1 Reactions 24 May 2014 No. 1502 0114-9954/14/1502-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
Transcript of Peginterferon-α/ribavirin/telaprevir
Reactions 1502, p31 - 24 May 2014
SPeginterferon-α/ribavirin/telaprevir
Thrombotic microangiopathy: case reportA 53-year-old woman developed thrombotic
microangiopathy while receiving peginterferon-α, ribavirinand telaprevir for hepatitis C.
The woman presented to an emergency department afterhaving collapsed in the hepatology outpatient unit. She hadbeen receiving triple hepatitis C treatment comprising ribavirin600mg twice daily, telaprevir 750mg three times daily [routesnot stated] and SC peginterferon-α 180µg weekly, for12 weeks prior to admission. She reported a 1-week history ofnausea, vomiting and fatigue, and was observed to have adiffuse maculopapular rash on her trunk and limbs. Testsshowed elevated creatinine and lactate dehydrogenase levels,with low haemoglobin and platelet levels. A urinalysis waspositive for protein and blood. Undetectable haptoglobins andred cell fragments were evident on blood film. A renal biopsyshowed microthrombi and fragments in the small vessels andglomeruli. She was diagnosed with thromboticmicroangiopathy, which was thought to be caused by herhepatitis C treatment.
The woman’s antiviral treatment was stopped, and she wasgiven seven sessions of plasma exchange. Her acute kidneyinjury subsequently resolved, and her platelet countnormalised.
Author comment: "[T]his is the first description of[thrombotic microangiopathy] complicating triple therapy.Telaprevir is an inhibitor of the hepatitis C NS3/4A serineprotease, which is required for viral replication. Interferonand ribavirin may induce [thrombotic microangiopathy]through an immunomodulatory effect."Evans R, et al. Thrombotic microangiopathy (TMA) in a patient treated withantiviral therapy for hepatitis C. BMJ Case Reports : No. 203290, 4 Apr 2014.Available from: URL: http://doi.org/10.1136/bcr-2013-203290 - UnitedKingdom 803103608
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Reactions 24 May 2014 No. 15020114-9954/14/1502-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved
