Chronic cough associated with interferon/ribavirin therapy for hepatitis C

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http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2710.2010.01182.x/abstract

Chronic cough associated with interferon/ribavirin therapy for hepatitis C

P. V. Dicpinigaitis MD, F. R. Weiner MD

Article first published online: 30 SEP 2010

DOI: 10.1111/j.1365-2710.2010.01182.x

© 2010 Blackwell Publishing Ltd

Issue

Journal of Clinical Pharmacy and Therapeutics

Volume 36, Issue 3, pages 416–418, June 2011

Summary

What is known and Objective:  The combination of pegylated interferon and

ribavirin has become standard therapy for chronic hepatitis C infection. The

occurrence of chronic cough associated with this treatment regimen has been

reported, but the mechanism by which cough occurs has not previously been

investigated. We measured cough reflex sensitivity, during and after completion

of therapy, in four patients who developed chronic cough associated with

interferon/ribavirin therapy.

Case summary:  Four patients without history of respiratory symptoms developed

chronic cough temporally related to initiation of therapy with pegylated

interferon and ribavirin for chronic hepatitis C infection. Cough resolved

within 2–6 weeks after completion of a 48-week course of therapy. To measure

cough reflex sensitivity, capsaicin cough challenge testing was performed 1

month prior to cessation of therapy, and 1 and 2 months after completion of

treatment. In all patients, cough reflex sensitivity, as measured by C5, the

concentration of capsaicin inducing 5 or more coughs, was significantly enhanced

during treatment compared to 1 month after completion of therapy (P = 0·016).

What is new and Conclusion:  Previous studies have observed that cough occurs

more commonly in patients receiving the combination of interferon and ribavirin

compared to interferon alone, thus implicating ribavirin as the causal agent.

Our data demonstrate that it does so by reversible enhancement of cough reflex

sensitivity. Clinicians should be aware of this potential treatment-related

effect, so as to avoid unnecessary and costly diagnostic evaluations seeking an

alternative aetiology of cough.