Prednisone and Peginterferon

I found that there is an interaction with these drugs as some of us suspected. If any one else has any info please post.

Adverse Effect :
peginterferon alfa-2a has its effect decreased by, and decreases the effect of prednisone

Severity Level :  2    
      
Caution - The interaction may occur based on the mechanism of action of the co-administered medicines. Be alert for increased or decreased effect, depending on the combination of medicines.

Documentation Level :
Limited - Few reports of this interaction exist. These few reports usually consist of limited case reports where clinically sound justification of the interaction is found.

Probable Mechanism :
The glucocorticoid prednisone has been reported to decrease the biologic response to interferon alfa in a study involving 20 healthy volunteers. In vitro cell culture studies confirmed that other glucocorticoids (dexamethasone, hydrocortisone) have opposing effects with various interferons on immune response. Close clinical monitoring for immune status is required during coadministration.

Actions to be Taken :
1. use combination with caution
2. monitor patient clinically

peginterferon alfa-2a belongs to the class of Interferons
Genetically engineered (recombinant) proteins with antiviral, antiproliferative and immunomodulatory properties.

prednisone belongs to the class of Glucocorticoids
Derivatives of corticosteroid hormones with anti-inflammatory activity. Some glucocorticoids are metabolised by CYP450 and may interact with other drugs metabolised by this system.

Reference :
Nunez BS, Geng CD, Pedersen KB et al: Interaction between the interferon signaling pathway and the human glucocorticoid receptor gene 1A promoter. Endocrinology (2005) 146 (3/Mar): 1449-57

Kleinert H, Euchenhofer C, Ihrig-Biedert I et al: Glucocorticoids inhibit the induction of nitric oxide synthase II by down-regulating cytokine-induced activity of transcription factor nuclear factor-kappa B. Mol Pharmacol (1996) 49 (1/Jan): 15-21

Witter FR, Woods AS, Griffin MD et al: Effects of prednisone, aspirin and acetaminophen on an in vivo biologic response to interferon in humans. Clin Pharmacol Ther (1988) 44 (2/Aug): 239-43

Fuggetta MP, Graziani G, Aquino A et al: Effect of hydrocortisone on human natural killer activity and its modulation by beta interferon. Int J Immunopharmacol (1988) 10 (6): 687-94

[Deb_c430]

This is very interesting, i know that many who have had transplant, (not liver, in the old days) who found because of the steroids, not long  after had to also   have liver transplants.

I also have thought for a long time steroids had a lot to do with with my relapse,

Thanks for sharing mikkie

[pigeonca]

Yet cortisone creams for skin problems seem usually to be safe.  I used them throughout tx, along with some other strong skin remedies, with no trouble.  Wonder why that is?  I mean, the skin is an adequate delivery system for lots of meds, like nicotine or birth control patches.  Maybe there's a threshold of some sort.

[Mikkimoe]

I would imagine it would be due to the concentration. Over 10 mgs is more significant. The lotions probably have much less.  I am at 7.5 but will try to titrate back to 5 for tx. I believe the body uses about 4 p/d in the adrenal gland which tends to not work after years of steroids (been 13 yrs for me).

Deb - that is interetsting about your use during tx...we discused before but i forgot - how long and how much were you on?

[Wassup]

Hey Mikki, I've recently stopped needing my Advair Inhaler, and was hoping to be able to quit using it forever, (if possible). I would imagine that this steroid, while inhaled, does enter the system, and would probably also have an adverse reaction for SVR .  Ya think?  That would be ANOTHER good reason to quit smoking.  What's your take on the Advair???  Hugs, Ant B

[Deb_c430]

Ok prendisone.  I had my accident Mar 5, 05 in a coma 6 weeks,  I failed a stym test, (adrenal gland) Also for lungs and bones.

I am not sure how much I was on at first, I do know there was another steroid also involved.     After I came back from U.S. I stayed on prendisone. they had started to ween me of one of the steroids. Staying with prendisone.

In the mean my liver levels shot up to 800 900, I panicked of course,  This was in May 05, Starting re thinking txing, my GI did not want me to start treating hepc till I came off the prendisone.    So I took another stym test, passed and my Endocrine  Doctor, starting me weening me down, when I was at a low dose (sorry don't remember would go look but no energy to dig through all that)

I then started treating with Pegysus and riba. 48 weeks. IN August 05

I was totally weened from Prendisone, in  Feb 06, I slept almost straight for three days last pilll.

My GI was always concerned with the steroids and when I relapsed he spent a llot of time trying to research into it. Then he went to Iraq, so not sure where he ever got with it.

Remember also I am a 1a, my strain is hardest to treat, your lucky being a 2, chances of success much better. You treat also if I remember right for a shorter period.

Deb

[pigeonca]

Oh, I forgot that I also used an inhaler for my asthma, Q-Var, which is some sort of steroid.  And albuterol when needed (it's also a steroid, stronger than the Q-Var).  None of this prevented my SVR.  So I really think it takes a goodly amount of the stuff to interfere with the Interferon.

[sldb]

Hep told me early in tx never to take steroids, b/c if there is any circulating virus in your body it will cause it to replicate. 1 mth prior to completing tx. i had an anaphylatic rxn to crayfish, i was terrified.  I spent 2 days in the hospital recieving iv steroids for my allergic rxn.  On top of that i was sent home on 2 weeks of steroids.  Luckily I remain UND 18 mths post tx.  

[Mikkimoe]

Thanks Deb for defogging my brain on that - that was a hell of a time....wonder if the pred had anything to do with it...I wish there was more research, seems like so many people take it that there would be...I'll keep searching.

Pig and Aunt B, sldb - From what I can see on the Advair I'd say it probably has a substantial amount of steriod in it. Lots of sides with it and tons of drug interactions.

http://www.****.html

[Deb_c430]

I wish so also, there are so many meds with steroids in them,  A catch 22 sort of! I mean I guess if I had to choose being alive, being able to breath,  I would choose that over HCV.  

There is so much research that needs to be done on this virus,  a lot can of it can only be done with time, proper ACCURATE research not guesses,

[pigeonca]

I agree with Deb that being able to breathe takes precedence over SVR.  Or if you have something like MS, being able to walk.  But I really think it usually takes a lot of steroids to do damage.  Advair lists all sorts of interactions and adverse effects, as do most meds.  The pharmaceutical companies are often just playing CYA when they generate those lists.

This of course leaves us in the dark as to the difference between what's bad and what's REALLY bad for us.  It's hard to know.

[Deb_c430]

I totally agree with that, so often the information you get depends on the drug company the Docs use.  It sure is hard to know!

The one thing (well more than one, I would be dead if in a regular hospital,)   About military Docs is they have no allegance to and drug companies nor are they compansated like reg Docs.