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Recurrent respiratory papillomatosis
Published in Declan Costello, Guri Sandhu, Practical Laryngology, 2015
Alpha interferons are naturally occurring polypeptides that have antiviral and anti-proliferative effects due to immune modulation. They have been used for RRP and the effect is dose-dependent.41 The heterogeneity of the studies performed make it difficult to make direct comparisons between published reports. More than 70% of patients show a positive response to alpha interferon. A review of four reports42–45 totalling 127 patients demonstrates 35% complete response, 38% partial response, 21% to have a minimal response and 5.5% no response. Grouping these data shows 73% to have a response and approximately 27% to have minimal or no response. This group compares well with a separate large uncontrolled study of 169 patients in which 73% had complete remission and the remainder had a significant reduction in the number and size of lesions.46 The effectiveness of alpha interferon therefore appears to be similar to cidofovir. A major difficulty with alpha interferon therapy is that systemic treatment is required; there are significant side-effects and monitoring of blood counts and liver function is required.47 There are numerous protocols ranging from 6 months to 2 years. The RRP taskforce guidelines state: “5 million units per metre squared body surface area by subcutaneous injection daily for 30 days and then 3 times weekly for at least a 6 months trial. The dose can be reduced to 3 million units/metre2 3 times a week if side-effects are severe” (http://www.rrpf.org/RRPTaskForceGuidelines.html). The value of a gradual reduction in dose is to prevent recurrence/rebound. The newer peg-interferon alfa-2a (Pegasys®, Roche) has a longer half-life and requires less frequent administration (once weekly) and has fewer side-effects.48
Immunomodulatory Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
In clinical practice, recombinant IFN-α formulations exist in 3 isoforms (alfa-2a, alfa-2b, and alfa-2c). Peginterferon alfa-2a (marketed under the name Pegasys™) is approved as adjuvant treatment for patients with completely resected Stage 3 or Stage 4 high-risk melanoma, as first-line treatment for patients with mRCC (alfa-2a, and alfa-2b in combination with bevacizumab), AIDS-related Kaposi’s sarcoma (alfa-2b), follicular lymphoma (alfa-2b), HCL (alfa-2a, alfa-2b), chronic myelogenous leukemia (Philadelphia chromosome-positive alfa-2a), condyloma acuminata (alfa-2b), and cervical intraperitoneal neoplasms (alfa-2b). Peginterferon alfa-2b (marketed as ViraferonPeg™) is approved for the treatment of hepatitis C. Two non-pegylated preparations (IntronA™, Roferon-A™) are also approved for administration by subcutaneous or intramuscular injection. The polyethylene glycol-conjugated (i.e., “pegylated”) derivatives of interferon alfa have enhanced persistence in the bloodstream due to their peg coating, although these products are mainly used in the treatment of chronic hepatitis B and C, often in combination with ribavirin. In some countries, interferon alfa-2a (rbe) is also used in a topical eye formulation for the treatment of ocular surface squamous neoplasia (OSSN), a cancer of the eye. IntronA™, which contains interferon alfa-2b (rbe), is approved for use in hairy cell leukemia and chronic myelogenous leukemia (CML) either as monotherapy or in combination with cytarabine, and is also used to treat lymph or liver metastases of carcinoid tumors, follicular lymphoma, maintenance of remission in multiple myeloma, and as an adjunct to surgery in malignant melanoma. It is also approved for use in chronic hepatitis C. Roferon-A™, which contains interferon alfa-2a (rbe), is used to treat AIDS-related Kaposi’s sarcoma, recurrent or metastatic renal cell carcinoma, hairy cell leukemia, chronic myelogenous leukemia (CML), progressive cutaneous T-cell lymphoma, and follicular non-Hodgkin’s lymphoma. It is also used as an adjunct to surgery in malignant melanoma and to treat chronic hepatitis B and C.
Pharmacotherapy for recurrent respiratory papillomatosis (RRP): a treatment update
Published in Expert Opinion on Pharmacotherapy, 2021
The pegylated form of alpha-interferon (peg-interferon alfa-2a, Pegasys®, Roche) is thought to enhance alpha interferons activity [51]. It requires less frequent administration (once weekly) and has fewer side effects [52]. The pegylated form has been used with granulocyte monocyte colony-stimulating factor (GM-CSF) to treat AORRP patients [53]. 9/11 patients who had this treatment administered subcutaneously had no relapse during treatment. This may indicate that the effects of pegylated alpha-interferon deliver enhanced outcomes.
A real-world observational study of drug utilization and clinical outcomes of direct-acting antivirals and interferon therapy for hepatitis C treatment in Taiwan
Published in Current Medical Research and Opinion, 2021
Jia-Hung Chen, Pei-Ning Wu, Sin-Chi Huang, Pao-Ju Hsu, Jason C. Hsu
The interferon included in this study includes: ribavirin (ATC code: J05AP01), interferon alfa-2a (L03AB04), interferon alfa-2b (L03AB05), interferon alfacon-1 (L03AB09), peginterferon alfa-2b (L03AB10) and peginterferon alfa-2a (L03AB11). Peginterferon in combination with ribavirin was not included in this study.
Treatment patterns and direct medical costs among patients with advanced hepatocellular carcinoma
Published in Current Medical Research and Opinion, 2020
Abdalla Aly, Elisabetta Malangone-Monaco, Virginia Noxon, Caroline Henriques, Fernando Benavente, Amy Kim
The limitations of this study are similar to other administrative claims analysis. First, due to the lack of any clinical detail related to staging and lines of therapy, the analysis relied on available codes to determine diagnoses and treatment. While we defined first systemic therapy received as first-line and subsequent systemic therapy as second-line, there is no evidence in the data to confirm whether there was progression in disease or intolerance to the previous treatment. In addition, treatments are limited to those used through January 2019, so any conclusions based on observed treatment patterns should be within the context that they reflect older guidelines for treating HCC and do not include newer treatments that were not available or only limitedly available during this study period. Similarly, as HCC lacks a specific diagnosis code, there is the potential for misclassifying these patients and including other non-HCC but liver-related cancers such as cholangiocarcinoma patients. The reliance on codes in claims data also impacts the ability to discern individual embolization procedures as there is overlap in the codes used (e.g. TAE/TACE). Another potential bias due to the reliance on codes is that the analysis is limited to available codes for treatments and does not capture any samples provided or treatments without codes. In addition, treatments such as peginterferon -alfa-2A, which can be used for other reasons, may not reflect actual systemic treatment for HCC as specific reasons for why treatment was administered was not captured. The study design did account for some overlap in systemic chemotherapy by excluding other primary cancers and use of prior chemotherapy, other reasons for chemotherapy outside of cancer, such as peginterferon-alfa-2A for HCV, may not have been excluded and could lead to overestimation of some treatments. Second, while we adjusted for observed baseline differences in patient characteristics, there are several factors that may influence treatment selection and healthcare costs that are not captured in administrative claims and could not be controlled for. These include but are not limited to tumor burden, tumor location, and Child-Pugh score6. Third, as this study was limited to a convenience sample of patients with commercial or Medicare supplemental insurance, the results may not reflect the entire HCC population. In particular, patients with Medicaid or no insurance have been reported to be less likely to receive systemic treatment for HCC than similar patients with commercial or Medicare insurance43.