Autoimmunity and peginterferon therapy for polycythemia vera

Area of Science:

• Immunology
• Endocrinology
• Oncology

Background:

• Peginterferon-alfa is a key treatment for myeloproliferative neoplasms (MPNs).
• This therapy can induce significant autoimmune complications, affecting various organ systems.
• These include beta-cell, thyroid, and systemic immune injury, leading to conditions like Type 1 diabetes, autoimmune thyroiditis, lupus, and Sjögren's syndrome.

Purpose of the Study:

• To review the mechanisms by which peginterferon-alfa induces autoimmunity.
• To highlight the spectrum of autoimmune diseases associated with peginterferon-alfa therapy.
• To discuss risk assessment, monitoring, and management strategies for these adverse events.

Main Methods:

• This is a narrative review based on existing literature.
• The review synthesizes information on peginterferon-alfa's immunomodulatory effects.
• It examines clinical presentations, risk factors, and outcomes of induced autoimmunity.

Main Results:

• Peginterferon-alfa can trigger autoimmunity in genetically predisposed individuals with subclinical autoimmune conditions.
• Onset of autoimmune conditions can occur during treatment or be delayed post-cessation.
• Type 1 diabetes is often irreversible, while thyroiditis and lupus may improve after treatment withdrawal, though autoantibodies may persist.

Conclusions:

• Pre-treatment risk assessment, including family history and specific biomarkers (thyroid function, anti-GAD antibodies), can identify high-risk patients.
• Close clinical and laboratory monitoring during and after therapy is essential for early detection and intervention.
• Proactive management can mitigate the risk of irreversible complications, especially Type 1 diabetes.