Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Interferon gamma
See also Interferons .
General information
Recombinant interferon gamma (interferon gamma-1b) is currently approved only as an adjunct to antibacterial therapy in chronic granulomatous disease [ ], although its immunoregulatory potential has been investigated in other diseases. Clinical experience with interferon gamma is therefore limited and the most relevant information on long-term safety has been obtained from the ICGDSCG trial [ ]. In this study, adverse reactions that were significantly more frequent with interferon gamma-1b (1.5 micrograms/kg or 50 micrograms/m 2 ) than with placebo included mild fever and flu-like symptoms, headache, and moderate injection site reactions. There were no adverse consequences on growth and development in children followed for a mean of 2.5 years [ , ]. Several other adverse effects have been reported to the manufacturers, but causal evaluation is lacking [ ].
Interferon gamma has been investigated in 27 patients with systemic sclerosis randomized to receive interferon gamma for 12 months. Most of them complained of symptoms consistent with a flu-like syndrome, namely headache (85%), fever (81%), and arthralgia and myalgia (70%) [ ]. There were adverse events (one or more per patient) leading to treatment withdrawal in four cases, including arthralgia, cardiac pain, atrioventricular block, reversible loss of hearing, and impotence; however, a causal relation with interferon gamma was not documented.
Organs and systems
Cardiovascular
Heart rate, ventricular or supraventricular extra beats, and asymptomatic cardiac events were not significantly different during treatment compared with baseline in 20 patients receiving interferon gamma [ ]. Interferon gamma rarely produced cardiovascular adverse effects. Hypotension, dysrhythmias, and possible coronary spasm were sometimes observed, mostly in patients receiving high doses or with previous cardiovascular disorders [ , ].
Exacerbation of Raynaud’s syndrome occurred in five of 20 patients with systemic sclerosis treated with interferon gamma [ ].
Respiratory
Of 10 patients treated with interferon gamma-1b 200 micrograms three times a week for advanced idiopathic pulmonary fibrosis, four developed irreversible acute respiratory failure [ ]. All four had increasing dyspnea, fever, and rapidly progressive hypoxemia, and had new alveolar opacities on lung imaging. The symptoms occurred shortly after interferon gamma had been started in three patients, and after 35 injections in the fourth. Three patients died from refractory hypoxemia and the fourth underwent lung transplantation, but died a few weeks later. Pathological examination in two patients showed diffuse alveolar damage with pre-existing interstitial pneumonitis. Interferon gamma was suspected, as no other cause of abrupt pulmonary deterioration was found. Although the number of patients was small, the authors noted that before interferon beta pulmonary function tended to be worse in the four patients who developed acute respiratory failure than in the other six.
In a double-blind study in 330 patients with idiopathic pulmonary fibrosis randomized to receive interferon gamma-1b or placebo, there were no significant differences in progression-free survival or in conventional measures of lung function, gas exchange, or quality of life [ ]. As expected, patients who received interferon gamma-1b had more frequent constitutional symptoms, such as fever, rigors, and flu-like symptoms. They also had more frequent upper respiratory tract infections and episodes of non-fatal pneumonia.
Interferon gamma-associated lung toxicity has been further supported by a report of acute respiratory insufficiency after 4 months in a 68-year-old man with idiopathic pulmonary fibrosis [ ].
You're Reading a Preview
Become a Clinical Tree membership for Full access and enjoy Unlimited articles
If you are a member. Log in here