Sudden hearing loss in patients with chronic hepatitis C treated with pegylated interferon/ribavirin
Sudden hearing loss in patients with chronic hepatitis C treated with pegylated interferon/ribavirin
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DOI：
10.1111/j.1572-0241.2004.30372.x
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发表时间：
2004-05-01
影响因子：
9.8
通讯作者：
Ferenci, P
中科院分区：
文献类型：
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作者：
Formann, E;Stauber, R;Ferenci, P
背景：标准干扰素 (IFN)-α2 治疗有突发性听力损失的报告。这是第一份关于 6 例慢性丙型肝炎患者突发性听力损失的报告，其与聚乙二醇化 (PEG)-IFN alfa2a 或 b/利巴韦林联合治疗的时间关系。在一项正在进行的随机安慰剂对照试验中，比较了在新感染 HCV 基因型 1 的患者中添加 200 mg 金刚烷胺或安慰剂与 180 μg PEG-IFN α2a（PEGASYS(R)，罗氏，巴塞尔，CH）/周和 1-1.2 g 利巴韦林/天（COPEGUS(R)，罗氏，Nutley，美国）联合用药治疗的 3 名患者的情况。 突发性听力损失分别在治疗第 1 天和治疗第 4、23、25、36 和 40 周后出现耳鸣。 结论：约 1% 接受 PEG-IFN/利巴韦林联合治疗的患者可能会出现突发性听力损失。该比率与在未经治疗的人群中观察到的比率没有什么不同。可能涉及的机制包括干扰素的直接耳毒性、自身免疫和血液学变化。与已发表的因标准 IFN 导致听力障碍的病例相比，停止 PEG-IFN 治疗后听力损失并未完全缓解。另一方面，继续治疗后症状并未恶化。因此，当出现耳毒性症状时，是否继续或停止治疗取决于治疗医生的临床判断。
BACKGROUND: Sudden hearing loss has been reported on standard interferon (IFN)-alpha2 therapy. This is the first report on the occurrence of sudden hearing loss in six cases of chronic hepatitis C in temporal relation to treatment with pegylated (PEG)-IFN alfa2a or b/ribavirin combination therapy. Three patients were treated in an ongoing randomized placebo-controlled trial comparing the addition of 200 mg amantadine or placebo to the combination of 180 mug PEG-IFN alpha2a (PEGASYS(R), Roche, Basel, CH)/wk and 1-1.2 g ribavirin/d (COPEGUS(R), Roche, Nutley, USA) in de novo patients infected with HCV genotype 1. Sudden hearing loss and tinnitus developed on day 1 and after 4, 23, 25, 36, and 40 wk of treatment, respectively.CONCLUSIONS: Sudden hearing loss may occur in about 1% of patients on PEG-IFN/ribavirin combination therapy. This rate was not different to that observed in an untreated population. Possible mechanisms involved include direct ototoxicity of IFN, autoimmunity, and hematological changes. In contrast to published cases on auditory disability due to standard IFN, hearing loss did not fully resolve after discontinuation of therapy with PEG-IFN. On the other hand, symptoms did not worsen on continued treatment. Therefore, the decision whether to continue or to stop the treatment when signs of ototoxicity appear is based on the clinical judgment of the treating physician.