Conventional Symptomatic Treatment Research Articles

Long‐term treatment with interferon‐α2b for severe pruritus in patients with polycythaemia vera

Pruritus is a major clinical problem in patients with polycythaemia vera (PV). Conventional symptomatic treatment is unsatisfactory. Recently, a favourable effect of interferon-alpha on pruritus in patients with PV has been reported. Also, interferon-alpha suppresses the increased haemopoiesis in PV. However, long-term treatment with interferon-alpha may be hampered by side-effects and the inconvenience of chronic subcutaneous injection therapy. We conducted a long-term study (median follow-up 13 months) of the efficacy and tolerability of interferon-alpha in 15 patients (mean age 68 years) with PV and severe pruritus. Six patients were evaluable after 1 year. Pruritus significantly improved in 12/15 patients. Haematological control improved, as evidenced by a decreased number of phlebotomies from a mean of 4.3 in the year before the study to 1.8 while on interferon-alpha. Leucocyte and platelet numbers also decreased significantly. Five patients (33%) did not tolerate interferon-alpha. The effects of interferon-alpha could not be ascribed to an inhibitive effect on histamine production or to the disappearance of the abnormal erythroid progenitor clone, because erythropoietin-independent erythroid colony formation persisted during interferon-alpha treatment. We conclude that long-term interferon-alpha treatment is feasible and effectively relieves pruritus in patients with PV, but side-effects are an important concern. The optimal dose regimen that is well tolerated, relieves pruritus, and offers satisfactory haematological control at the same time remains to be established.

The state of the renin-angiotensin-aldosterone system in patients with the neuroendocrine-metabolic form of the hypothalamic syndrome.

1. Normalization of the baseline level of aldosterone in the blood, and of the reaction of the glomerular zone of the cortical substance of the adrenal glands and the juxtaglomerular apparatus of the kidneys, does not take place under the influence of conventional symptomatic treatment in NEMHS patients. 2. Treatment of NEMHS patients with peritol leads to normalization of the concentration of aldosterone in the blood; the reaction of the glomerular zone of the cortical substance of the adrenal glands and of the juxtaglomerular apparatus of the kidneys to both stimulators improves substantially. 3. The blood aldosterone concentration normalizes following the course of treatment with parlodel, while the reaction of the glomerular zone of the cortical substance of the adrenal glands and of the juxtaglomerular apparatus of the kidneys to insulin hypoglycemia does not change, while the reaction to an acute load of furosemide improves.