Interferon-Associated Retinopathy During the Treatment of Chronic Hepatitis C

A Systematic Review

A. Raza; S. Mittal; G. K. Sood

Disclosures

J Viral Hepat. 2013;20(9):593-599. 

In This Article

Abstract and Introduction

Abstract

The incidence of retinopathy in patients with chronic hepatitis C treated with interferon-based regimens has been variably reported in the literature. There is no consensus regarding ophthalmologic screening before and during treatment with interferon-based therapy. To assess the incidence of retinopathy in patients with chronic hepatitis C being treated with interferon-based regimens and estimate the rate of resolution. A systematic literature search was performed to locate all relevant publications. Pooled incidence of retinopathy was calculated in patients treated with interferon or pegylated interferon. We also estimated the rate of discontinuation of treatment and resolution after the treatment was stopped. A total of 21 studies fulfilled the inclusion criteria. The overall incidence of retinopathy using random effect model was 27.7% (95% confidence interval [CI] 20.9–34.5%). The pooled incidence of retinopathy in 10 studies that only used pegylated interferon was 20.9% (95% CI: 11.6–29.8). The incidence of retinopathy with pegylated interferon in diabetic and hypertensive patients (high-risk group) was 65.32% and 50.7%, respectively. This was significantly higher compared with the incidence of retinopathy (11.7%) in patients without these risk factors. Overall pooled estimate for the resolution of retinopathy was 87% (95% CI 75.7–98.4%). The rate of discontinuation of treatment was 6.3%. The incidence of retinopathy with pegylated interferon in patients without hypertension and diabetes is low, but the risk is higher in patients with diabetes and hypertension. Routine pretreatment fundoscopic screening may not be warranted in all patients and can be limited to the patients with these risk factors.

Introduction

In recent years, there have been significant advances in the treatment of chronic hepatitis C virus (HCV) infection. There are many new agents on horizon, and the novel interferon (IFN)-free regimens are being explored. But IFN-based regimens along with the new direct acting antiviral agents are likely to stay as part of hepatitis C treatment for the next few years.[1–3] Currently, pegylated interferon alpha (PegIFNα) is a part of all the standard regimens for the treatment of HCV. The development of retinopathy is a well-known side effect of the PegIFNα therapy.[4] However, the data report discordant results about the frequency and clinical significance of retinopathy seen during PegIFNα-based therapy. Retinopathy has been reported in 18–86% of patients with chronic HCV who received IFN-based treatment regimens, and the risk is even higher in diabetic and hypertensive patients.[4–6] The wide range of frequency reported in the literature reflects the limitations of small studies, which are heterogeneous in selection of the patients and screening protocols for retinopathy. Given the inconvenience and cost associated with the ophthalmological screening, significance of IFN-associated retinopathy during HCV treatment and lack of screening or surveillance protocols, we conducted a systematic review to estimate the incidence of retinopathy in patients with chronic HCV being treated with PegIFNα or IFNα and its outcomes. We specifically reviewed incidence in various high-risk groups, pertinently in patients with associated diabetes mellitus (DM) and hypertension (HTN). We also studied the rate of discontinuation of the treatment due to the development of severe retinopathy and the outcomes of retinopathy after the treatment was completed or discontinued.

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