Flink, H.J.

Complicated systemic lupus erythematosus pancreatitis: Pseudocyst, pseudoaneurysm, but real bleeding (Article)

2011-03-01T00:00:00Z

We report the case of a 25-year-old patient with systemic lupus erythematosus (SLE) pancreatitis which was complicated by pseudocyst and pseudoaneurysm formation. The pseudoaneurysm progressed to intra-abdominal bleeding requiring endovascular coil embolization of the gastroduodenal artery. The pseudocyst and hematoma formed two large abdominal fluid collections causing symptoms due to a mass effect. These fluid collections were treated conservatively, while active SLE was treated with steroids, azathioprine, and immunoglobulins. She finally made a full recovery. To the best of our knowledge, this is the first report of a bleeding pseudoaneurysm complicating SLE pancreatitis. Although anecdotal, this case may serve as a useful example of the possible complications of SLE pancreatitis, including considerations on optimal management. Lupus (2011) 20, 305-307.

Early hbeag loss during peginterferon α-2b therapy predicts HBsAg loss: Results of a long-term follow-up study in chronic hepatitis B patients (Article)

2009-10-01T00:00:00Z

OBJECTIVES:Treatment with pegylated interferon (PEG-IFN) α-2b results in hepatitis B e antigen (HBeAg) loss in 36% of patients at 6 months post treatment. The aim of this study was to determine whether a long-term response to PEG-IFN is dependent on the timing of HBeAg loss.METHODS:A total of 91 patients treated with PEG-IFN α-2b alone (100 g per week) and 81 patients treated with PEG-IFN α-2b and lamivudine (100 mg/day) for 52 weeks were enrolled in this study. Patients were initially followed up at 4-week intervals and had one additional long-term follow-up (LTFU) visit (mean: 3.030.77 years 26 weeks post treatment).RESULTS:Of the 172 patients included, 78 patients (46%) did not have loss of HBeAg, 47 (27%) lost HBeAg within 32 weeks, and 47 patients (27%) had loss of HBeAg after week 32. At LTFU, patients with HBeAg loss32 weeks had hepatitis B virus DNA of 400 copies/ml significantly more often than did those who lost HBeAg after week 32 (47 vs. 21%, respectively; P0.009). Hepatitis B surface antigen (HBsAg) negativity was also observed significantly more often in patients with early HBeAg loss (36 vs. 4%, respectively, P0.001). Early HBeAg loss tended to occur more often in patients treated with PEG-IFN and lamivudine combination therapy than in those treated with PEG-IFN alone (35 vs. 21%; P0.10), as did HBsAg loss (15 vs. 8%; P0.14).CONCLUSIONS:Early PEG-IFN-induced HBeAg loss results in a high likelihood of HBsAg loss and may be associated with more profound viral suppression during the first 32 weeks of therapy in patients treated with lamivudine combinations.

Sustained HBeAg and HBsAg Loss After Long-term Follow-up of HBeAg-Positive Patients Treated With Peginterferon α-2b (Article)

2008-08-01T00:00:00Z

Background & Aims: The aim of this study was to evaluate the long-term sustainability of response in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B treated with pegylated interferon (PEG-IFN) α-2b alone or in combination with lamivudine. Methods: All 266 patients enrolled in the HBV99-01 study were offered participation in a long-term follow-up (LTFU) study. Patients were treated with PEG-IFN α-2b (100 μg/wk) alone or in combination with lamivudine (100 mg/day) for 52 weeks. Initial response was defined as HBeAg negativity at 26 weeks posttreatment. For the LTFU study, patients had one additional visit after the initial study (mean interval, 3.0 ± 0.8 years). Results: Of 266 patients enrolled in the initial study, 172 (65%) participated in the LTFU study. At LTFU, HBeAg and hepatitis B surface antigen (HBsAg) negativity were observed in 37% and 11% of 172 patients, respectively. Sixty-four patients were classified as initial responders and 108 as nonresponders. Among the initial responders, sustained HBeAg negativity and HBsAg loss were observed in 81% and 30%, respectively. Significantly higher rates of HBeAg negativity were observed in genotype A-infected initial responders compared with those with genotype non-A (96% vs 76%; P = .06) as well as HBsAg loss (58% vs 11%; P < .001). Conclusions: HBeAg loss after treatment with PEG-IFN α-2b alone or in combination with lamivudine is sustained in the majority of patients and is associated with a high likelihood of HBsAg loss, particularly in genotype A-infected patients. Therefore, PEG-IFN α-2b remains an important treatment option in this era of nucleos(t)ide analogue therapy.

Relapse after treatment with peginterferon α-2b alone or in combination with lamivudine in HBeAg positive chronic hepatitis B (Article)

2007-10-01T00:00:00Z

Pegylated Interferon Alfa in HBeAg-positive Chronic Hepatitis B (Doctoral Thesis)

2006-12-01T00:00:00Z

Word-wide, infection with the hepatitis B virus (HBV) is a major health problem. Over 2 billion people have been exposed to HBV, and approximately 400 million are chronic carriers of the virus. Chronic hepatitis B (CHB) infection may lead in term to liver cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC), and is responsible for an estimated 1 million deaths annually. The efficacy of the established treatment for CHB is limited.Treatment with conventional interferon (IFN) is only effective in 20-35%. Lamivudine needs to be given long-term to maintain response and leads to emergence of viral resistant strains. Several studies have investigated different treatment options such as peginterferon, adefovir and entecavir.The first randomized controlled trial in HBeAg-positive CHB with peginterferon - which had proven to be more effective than conventional IFN in chronic hepatitis C patients demonstrated that a 52-week course of peginterferon alfa-2b leads to HBeAg seroconversion in 36%, ALT normalization in 35% and HBV DNA < 2.0 x 105 copies/mL in 32% of patients at the end of post treatment follow-up.The addition of lamivudine did not enhance response rates compared to peginterferon alfa-2b alone.The use of conventional IFN is not suited for all patients due to the significant side effects and early treatment discontinuation that may occur.Although the safety profile of peginterferon has been studied in chronic hepatitis C, the side effects of peginterferon in CHB patients have not previously been investigated. We assessed the safety of peginterferon treatment in 266 HBeAg-positive patients who received peginterferon alfa-2b alone or in combination with lamivudine (chapter 2). The most common side effects were similar to those reported for conventional IFN. Flu-like symptoms, headache, fatigue, myalgia, local reaction at the injection, abdominal discomfort and psychiatric symptoms were most frequently reported, but in general subsided during the course of therapy. Hematologic abnormalities (leucopenia, neutropenia and thrombocytopenia) were frequent but did not lead to serious infections or bleeding complications. Neutropenia was the major cause for dose reductions of peginterferon, whereas psychiatric symptoms (depression, psychosis) were the most important reasons for early treatment discontinuation. Pre-existing cirrhosis at baseline was an important risk factor for thrombocytopenia and (minor) bleeding complications.