Management of adverse effects of Peg-IFN and ribavirin therapy for hepatitis C

HCV infects approximately 2-3% of the global population and is a leading cause of end-stage liver disease and hepatocellular carcinoma. Treatment of HCV infection with Peg-IFN in combination with ribavirin can eradicate HCV infection in 40-90% of patients; however, a major barrier to treatment uptake and delivery is the association of this therapy with frequent and, at times, serious adverse effects. Recognition and effective management of these adverse effects are critical components of the successful treatment of chronic HCV infection. In clinical trials, approximately 10-15% of patients discontinue Peg-IFN and ribavirin therapy due to adverse effects; however, in clinical practice, the rate of treatment discontinuation has been reported to be substantially higher. The off-target effect of Peg-IFN and ribavirin impacts most, if not all, organ systems; the most common adverse effects are hematologic, dermatologic, neurologic, immunologic, gastrointestinal, pulmonary, cardiovascular, and ocular. Regional and global variability exists in the nature of these adverse effects and the strategies employed to ameliorate their impact. This article provides a comprehensive literature review that systematically describes the adverse effects of Peg-IFN-α and ribavirin on various organ systems and, more importantly, recommends consensus approaches to managing those effects. © 2011 Macmillan Publishers Limited. All rights reserved.

Sulkowski M.S.1 , Cooper C.2 , Hunyady B.3 , Jia J.4 , Ogurtsov P. 5 , Peck-Radosavljevic M.6 , Shiffman M.L.7 , Yurdaydin C.8 , Dalgard O.9
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  • 1 Viral Hepatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, United States
  • 2 Department of Medicine, Division of Infectious Diseases, Ottawa Hospital, Ottawa, ON, Canada
  • 3 Department of Medicine, Kaposi Mór Teaching Hospital, Kaposvár, Hungary
  • 4 Beijing Friendship Hospital, Xuanwu District, Beijing, China
  • 5 Russian Peoples' Friendship University of Medicine, Moscow, Russian Federation
  • 6 Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
  • 7 Liver Institute of Virginia, Bon Secours Virginia Health System, VA, United States
  • 8 Hepatology Institute, University of Ankara, Ankara, Turkey
  • 9 Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
beta adrenergic receptor blocking agent; clotrimazole; corticosteroid; eltrombopag; ketoconazole; levothyroxine; methylphenidate; metoclopramide; minoxidil; modafinil; mood stabilizer; neuroleptic agent; noradrenalin uptake inhibitor; ondansetron; peginterferon alpha; peginterferon alpha2b; prochlorperazine; promethazine; recombinant erythropoietin; ribavirin; sedative agent; serotonin uptake inhibitor; acne; acute febrile neutrophilic dermatosis; adjuvant therapy; adverse drug reaction; alopecia; anemia; angioneurotic edema; autoimmune disease; autoimmune hemolytic anemia; autoimmune thyroiditis; blindness; bone marrow suppression; bronchitis; bullous skin disease; cardiomyopathy; cardiovascular disease; cerebrovascular accident; chemotherapy induced emesis; chronic obstructive lung disease; cognitive defect; convulsion; cornea ulcer; coughing; depression; dermatitis; dermatomycosis; drug dose reduction; drug withdrawal; dry skin; dyspnea; eczema; erythema; erythema multiforme; exercise; eye disease; face edema; fatigue; furunculosis; gastrointestinal disease; Graves disease; hair texture; hemolysis; hemorrhagic colitis; hepatitis C; herpes simplex; human; hyperthyroidism; hypomania; hypothyroidism; infection; injection site abscess; injection site necrosis; injection site pain; injection site reaction; insomnia; insulin dependent diabetes mellitus; interstitial pneumonia; ischemic colitis; liver cirrhosis; lung disease; lung sarcoidosis; maculopapular rash; mania; mental disease; nail disease; nausea and vomiting; neutropenia; night sweat; optic nerve disease; optic neuritis; papilledema; pericarditis; peripheral edema; photosensitivity; pneumonia; polyneuropathy; porphyria cutanea tarda; portal vein thrombosis; priority journal; pruritus; psoriasis; psoriatic arthritis; pulmonary hypertension; retina artery occlusion; retina disease; retina hemorrhage; retina macula edema; review; rheumatoid arthritis; risk factor; sarcoidosis; side effect; skin disease; skin infection; Stevens Johnson syndrome; suicidal ideation; sweating; systemic lupus erythematosus; thrombocytopenia; toxic epidermal necrolysis; urticaria; visual field defect; visual impairment; xerosis; Antiviral Agents; Drug Therapy, Combination; Hepatitis C; Humans; Interferon Alfa-2a; Interferon Alfa-2b; Polyethylene Glycols; Ribavirin; Treatment Outcome
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