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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Recent years have seen a revolution in the treatment of chronic hepatitis C, with the addition of effective, well-tolerated oral therapies (directly active antiviral (DAA) therapies) to the older treatments of PEG-interferon-α and ribavirin. Pegylated-interferon-α augments human natural antiviral immune responses to increase viral clearance, but it has marked side effects of flu-like symptoms.DAA are taken for 8–12 weeks and clear hepatitis C (cure) in over 90% of patients.DAA include the protease inhibitor simeprevir and the non-nucleoside polymerase (NSSA) inhibitors sofosbuvir and ledipasvir. DAA are used alone or in combination, depending on patient characteristics and their hepatitis C strain type.
Viral hepatitis in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
During hepatitis C treatment, patients are not allowed to get pregnant. It is recommended that they use two forms of contraception. I do not treat any patients who are unable or unwilling to comply with this. The package insert for pegylated interferon recommends that patients do not get pregnant until 6 months post therapy. Practically speaking, if patients are very worried about their hepatitis C, and would like to get treated first before getting pregnant, this will usually mean a delay of 1 to 2 years depending on how they respond to therapy.
Early Intensification of Therapy: The Role of High-Dose Imatinib and Imatinib-Based Combinations
Published in Jorge Cortes, Michael Deininger, Chronic Myeloid Leukemia, 2006
Guilhot François, Martineau Géraldine, Millot Frédéric, Roy Lydia
In order to obtain a higher rate of cytogenetic response and to overcome resistances, new strategies using combination of cytotoxic drugs with imatinib have emerged. Drugs, which are currently tested, are those that have been selected in the past for their high antileukemic activity. Interferon, pegylated or nonpegylated forms, and cytarabine at various dosages are being actively tested. The conjugation of a 40kDa branched polyethylene glycol molecule to interferona2a (Peg-IFNa2a) results in the formation of a novel IFN with properties including sustained absorption and a prolonged half life, allowing for a once weekly dosing regimen. Thus this new compound could be better tolerated in CML patients. An open label trial included 144 patients comparing subcutaneous single-agent Peg-IFNα2a 450 mg once weekly with regular IFNα2a, 9 MU/day. After 12 months major cytogenetic response, complete cytogenetic response, as well as hematologic response were significantly better with Peg-IFNα2a as compared with regular IFNα2a, 35% and 18% ( p = 0.0016), 15% and 7%, 66% and 41% (0.0008) respectively (15). These results suggest that pegylated interferon is not only a more convenient alternative to regular interferon, but also possibly more effective.
Emerging drugs for hepatitis D
Published in Expert Opinion on Emerging Drugs, 2023
As mentioned earlier, the hepatitis D virus has a unique structure and life cycle. Compounds used in new treatment approaches target various steps of the HDV life cycle (Figure 1): 1- bulevirtide (BLV) inhibits entry of the virus into the hepatocyte 2- lonafarnib inhibits prenylation and thus interferes with virus assembly 3- nucleic acid polymers (NAPs) inhibit HBsAg release from the hepatocytes. The other treatment being studied is pegylated interferon lambda (PegIFNλ). New treatment options investigated in the treatment of hepatitis D are studied both as monotherapy and in combination with PegIFN. Of these new compounds, BLV has received conditional approval by the European Medicines Agency (EMA) in July 2020 and early access programs have been initiated in countries such as France, Italy, Germany and Austria enabling the reporting of first real-life data of bulevirtide (BLV) treatment for CHD.
Hepatitis D virus (HDV): investigational therapeutic agents in clinical trials
Published in Expert Opinion on Investigational Drugs, 2022
The advent of pegylated-interferon (PEG-IFN) through conjugation of standard interferon with polyethylene glycol was promising, with the hope of extending its plasma half-life and prolonging its immunomodulatory action. While PEG-IFNα demonstrates a modest benefit in controlled HDV, only 25–40% of treated patients has sustained virologic response after 1 year of therapy [9,61,62] One study with PEG-IFN alpha-2b therapy only induced sustained HDV clearance in ~20% of patients, with fewer achieving HBsAg loss [63]. More recently, a long-term follow up of a dose escalation interferon study evaluating patients with extended PEG-IFNα treatment duration found sustained HDV RNA clearance in more than half of patients, with functional HBV cure in 33% [64].
Treatment of Refractory Cystoid Macular Edema with Pegylated Interferon Alfa-2A: A Retrospective Chart Review
Published in Ocular Immunology and Inflammation, 2021
Hillary C. Stiefel, Laura J. Kopplin, Thomas Albini, Michael Chang, Sravanthi Vegunta, Eric B. Suhler
The frequent dosing and side effect profile of these regimens poses potential problems for patient compliance, making the idea of using a pegylated form of interferon that could be administered less frequently an attractive option. The term “pegylation” refers to the addition of nontoxic, nonimmunogenic, and highly water-soluble polyethylene glycol molecules to interferon. This process prolongs the half-life of the interferon molecule, decreasing its clearance and allowing for a longer duration of action. Pegylated interferon is FDA approved as part of a combination treatment of chronic hepatitis C.