Steve Cree

Information about Peginterferon

What Is Peginterferon:
Peginterferon is an injectable drug used for treating chronic hepatitis infections (hepatitis C, hepatitis B) and some cancers. It's a man-made version of a human protein (interferon alpha) that your body makes to fight viral infections.

Peginterferon is a shortened word for pegylated interferon, which is interferon that's engineered to only need one injection every week. The original version of the drug (regular interferon) required up to three injections every week. Due to the pegylation, peginterferon is more convenient, more effective and has nearly replaced regular interferon as a therapy.

What Are Other Names for Peginterferon:
There are basically two types of peginterferon: Pegasys (also known as peginterferon alfa-2a) and PegIntron (also known as peginterferon alfa-2b). These drugs are very similar and have only minor differences between them.
Does Peginterferon Effectively Treat Chronic Hepatitis C:
The most effective way to treat hepatitis C is with a combination of peginterferon and ribavirin. Treating hepatitis C with just peginterferon is rarely done. Successful treatment (sustained virologic response) depends on the type of hepatitis C and the characteristics of the patient being treated. For example, a healthy patient with a genotype 2 infection will usually have a successful treatment; however, a patient with diabetes HIV infection and genotype 1 has less than a 35% chance of successful treatment.
Does Peginterferon Effectively Treat Chronic Hepatitis B:
Peginterferon is rarely used for treating hepatitis B in the United States. Treatment with peginterferon works somewhere between 15% and 40% of the time, depending on your infection. Some people relapse after treatment stops, which means that the virus starts replicating again. Unlike hepatitis C, though, other treatments are available for hepatitis B.
How Do I Take Peginterferon:
Peginterferon must be injected, usually under the skin. Your nurse will teach you how to correctly do the injections, and you'll quickly be able to do it by yourself. You also need to keep the medicine refrigerated.
How Much Peginterferon Do I Need to Take:
You take one injection of peginterferon every week. Your exact dose will depend on many factors, including which type of peginterferon you take and your particular viral infection.
How Much Does Peginterferon Cost:
A full course of peginterferon treatment is expensive, almost $20,000 for a year. As a drug for chronic hepatitis C, it's the only effective treatment available, especially when combined with ribavirin. In the United States, most health insurance will cover the cost of peginterferon and ribavirin for hepatitis C treatment.

For chronic hepatitis B, there are other more effective treatment drugs available that are also much cheaper, but peginterferon remains a useful therapy for some people.

What Are the Side Effects of Peginterferon:
There are many side effects from taking peginterferon. Here is a list of the most common side effects.
Who Should Not Take Peginterferon:
Some people should not take peginterferon. Here are examples of medical conditions that may keep you from using this medication:
  • Advanced liver, heart, kidney or lung disease
  • Autoimmune disease
  • Severe depression or other psychiatric conditions
  • Pregnancy
  • Breast-feeding

Sources:

Dienstag, JL. Chronic Hepatitis. In: AS Fauci, E Braunwald, DL Kasper, SL Hauser, DL Longo, JL Jameson, J Loscaizo (eds), Harrison’s Principles of Internal Medicine, 17e. New York, McGraw-Hill, 2008.

Friedman, LS. Liver, Biliary Tract, & Pancreas: Chronic Viral Hepatitis. In: LM Tierney, SJ McPhee, MA Papadakis (eds), 2007 Current Medical Diagnosis and Treatment, 46e. New York, McGraw-Hill, 2007.

Katzung, BG. Basic and Clinical Pharmacology, 10e. New York, McGraw-Hill, 2007.

Pegasys Medication Guide. http://www.rocheusa.com/products/pegasys/PEGASYS_MedGuide.pdf.

PegIntron Medication Guide. http://www.spfiles.com/pipeg-intron.pdf#page=8.

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Most Common Side Effects.

Peginterferon (also known as Pegasys or PegIntron) is a drug that treats chronic hepatitis infection (hepatitis C, hepatitis B). Even though peginterferon closely resembles a natural protein that your body uses to fight infection (interferon alpha), you will probably experience side effects from treatment. Here are the most common side effects from taking peginterferon:
  • Flu-like symptoms. This is a collection of familiar symptoms that include headache, fever, chills, and muscle aches.
  • Trouble sleeping (insomnia)
  • Depression and other changes in your mood. You should take extra precautions if you have had depression in the past and are taking peginterferon. Most side effects can be controlled with antidepressants or other medicines, but it's important to respond quickly to any behavioral change.
  • Nausea and vomiting
  • Skin rashes
  • Extreme tiredness
  • Loss of appetite and weight loss

Some people may experience many more side effects. Here is an extensive list of side effects from peginterferon treatment.

As noted above, peginterferon can treat both hepatitis B and C. However, in the United States, doctors rarely use peginterferon to treat hepatitis B, choosing, instead, other treatment options. For hepatitis C, doctors nearly always combine peginterferon with ribavirin for the best treatment.

Sources:

Package Insert for Pegasys. http://www.fda.gov/CDER/foi/label/2002/pegihof101602LB.htm.

Pegasys Information. http://www.rocheusa.com/products/pegasys/pi.pdf.

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Extensive Side Effects.

The most common side effects for peginterferon (such as Pegasys or PegIntron) are fatigue, headache, fever, muscle pain and chills. However, other possible side effects are listed below. Although these side effects are specifically for Pegasys (a brand name peginterferon alfa-2a drug for treating hepatitis C and sometimes hepatitis B), they are similar to any other peginterferon such as PegIntron.

How Are These Side effects Determined?

Before a drug (such as Pegasys) can be licensed as an approved treatment for hepatitis B and hepatitis C, it has to be tested in clinical trials. Clinical trials are scientific studies that determine if the drug is safe and what are the side effects. The side effects listed below were determined by treating 559 people with 180 micrograms of Pegasys for 48 weeks. The number listed after each side effect is the percentage of the 559 people in the clinical trial who reported that particular side effect.

How to Understand This List of Side Effects

This list of side effects is arranged in order of frequency, which means that more people in the study group reported the side effects at the beginning of the list than at the end of the list. Since peginterferon will react a little differently in each person, this list should be considered only as a general guide. However, by using the list below, doctors know that about half of their patients on peginterferon will suffer fatigue and can then help prepare them for this.

Should I Be Concerned about These Side Effects?

You should absolutely know and understand these side effects. Sometimes it's helpful to know what the side effects are so that you can better prepare for them. For example, if you have trouble with depression, taking this medication could worsen your usual episodes because almost 20% of people report depression while on this medicine. By knowing that depression is a potential side effect, you and your doctor can discuss solutions such as prescribing antidepressants before you begin this treatment.

It's also important not to be discouraged by these side effects. Every medication will have some unwanted effects, but taking this drug gives you the best chance of a successful treatment in exchange for having side effects. As potentially better treatments are introduced, you can compare their effectiveness against their side effects and, with your doctor, make an informed decision on your treatment.

Where Do I Get This Information?

The side effects (also called adverse reactions) of every drug must be determined through extensive clinical trials before the drug can legally be sold in the United States. The source of this list is from the Pegasys package insert which can be read from the drug manufacturer or the US Food and Drug Administration.


A Complete List of Peginterferon Side Effects
Side Effect Percentage Reporting
Fatigue 56%
Headache 54%
Fever (pyrexia) 37%
Muscle pain (myalgia) 37%
Shivering (Rigors) 35%
Joint pain (arthralgia) 28%
Nausea/Vomiting 24%
Hair loss (alopecia) 23%
Injection site reaction 22%
Neutropenia 21%
Irritability and nervousness 19%
Trouble sleeping (insomnia) 19%
Depression 18%
Loss of appetite (anorexia) 17%
Diarrhea 16%
Dizziness (not vertigo) 16%
Belly pain 15%
Itchiness (pruritus) 12%
Pain 11%
Resistance Mechanism Disorders 10%
Back pain 9%
Dermatitis 8%
Trouble concentrating 8%
Dry mouth 6%
Increased sweating 6%
Loss of some memory 5%
Rash 5%
Thrombocytopenia 5%
Blurry vision 4%
Cough 4%
Dry skin 4%
Shortness of breath (dyspnea) 4%
Weight loss 4%
Changes in mood 3%
Hypothyroidism 3%
Lymphopenia 3%
Anemia 2%
Eczema (general skin inflammation) 1%
Shortness of breath on exertion <1%*
Upset stomach (dyspepsia) <1%*
*This means that less than 1% of the study group reported this side effect.