Early Treatment with Interferon provides better Patient Outcomes
Second in ASH 2016 Series
by David Wallace
Dr. Jean–Jacques Kiladjian, MD, PhD is the head of the Clinical Investigation Center at Saint–Louis Hospital and a professor at Paris Diderot University in Paris, France. Dr Kiladjian and David Wallace discuss the outcomes of a retrospective study of 333 MPN patients who had undergone interferon therapy at some point in their treatment history:
Summary of Key Points:
- Out of the 333 patients, 149 had discontinued interferon treatment. 50% of those discontinued because of some kind of toxicity (autoimmune or thyroid problem).
- 35% of patients discontinued because of hematological remission (normal blood counts).
- 20-25% remained off interferon successfully (hematological remission) for a median of 3 years and a maximum of 11 years.
- Patients that attained hematological remission and stayed successfully off interferon the longest had typically tapered their dose down over time to a low amount, given less frequently.
- Patients who had a lower allele burden (preferably < 5-10%) after treatment were more successful staying in remission. They also had typically started treatment earlier.
- Benefits of a molecular response (lowered allele burden) include less treatment, including discontinuation of medication, less thrombotic events and lower likelihood of transformation.
- Further research would include a prospective study to confirm the results of discontinuation of interferon. Patients would likely have at least two years of interferon treatment, to try to reduce the allele burden down to <5% and discontinue treatment.
- Patient Perspective (author’s note): Interferon can be a difficult drug to take, due to the side effect profile particularly with increasing dosage. Conversely, many patients do well on interferon without many side effects. The introduction of Ropeginterferon alfa 2b (P1101 – a new generation interferon by PharmaEssentia, from the Proud PV study) should provide better response rates, a lower toxicity profile and less frequent dosing. PharmaEssentia plans to apply for its approval as first line treatment in PV in a number of markets, including the USA. If approved, it is expected to be the first interferon approved for PV and the only FDA approved first-line treatment for Polycythemia Vera (PV).