Peripheral Neurotoxicity Of Pegylated Alpha Interferons (Peg-Ifns): Prospective Study In Chronic Hepatitis C

Objective: To assess whether pegylated interferons (PEG-IFNs) treatment is associated with occurrence, worsening or improvement of peripheral neuropathy in HCV patients. Background: Alpha-IFN is associated with central nervous system side effects. There are reports of both improvement and worsening of neuropathy during alpha-IFN treatment, but the possible alpha-IFN peripheral neurotoxicity has never been consistently investigated. Patients and Methods: Twenty-six HCV patients (19 male, 7 females, median age 41.5 ± 9.6 years) have been treated with PEG-IFNs (alpha-2a 180 mcg weekly or alpha-2b 1.5 mcg, weekly) and ribavirin for 6–12 months. Eleven patients had neuropathy at recruitment (two diabetic, nine HCV-related neuropathy, one with cryoglobulins). Before therapy (T0) all patients underwent quantitative viral RNA determination, HCV genotype analysis, liver biopsy, neurological and electrophysiological evaluation. Response amplitude and conduction velocities of median, ulnar, sural, and peroneal nerves were recorded. During therapy (T1)(mean follow-up 7,8 ± 4.0 months), patients were neurologically and electrophysiologically re-evaluated. Eighteen HCV patients (11 males, 7 females, median age 47.4 ± 9.6) with comparable viral load, not in IFN treatment, were studied as controls. Results: During PEG-IFNs therapy, no significant differences of all electrophysiological parameters were detected between T0 and T1 evaluations (repeated measures ANOVA) in all 44 treated and non-treated patients, also in those with neuropathy at recruitment. No correlations were found between electrophysiological parameters and length of therapy (Spearman's Rho). Conclusions: Peripheral neuropathy seems not to complicate PEG-IFNs therapy in HCV patients. An ongoing follow-up study on a larger group of patients will help confirm these results.