44 The authors have reported that the

use of IFN to treat hepatitis C is expected to increase. Changes to immune system regulation associated with combination therapy, as well as specific adverse reactions, such as UC, may occur at a significantly higher frequency than with IFN monotherapy.10,13 To date, the number of cases of UC has shown little increase in Japan despite the fact that combination therapy of IFN and RIB has become widespread, and no studies have been published in this regard (Tables 1 and 2). However, avoiding combination therapy or decreasing doses of IFN and RIB may have prevented UC exacerbation in patients with a history of hematochezia or UC. Caution is advised when administering Carfilzomib nmr combination therapy to patients with chronic hepatitis C and

a history of UC or hematochezia. Katsanos et al. reported that the incidence of hypothyroidism after treatment with a combination of IFN and RIB was similar to that occurring after treatment with IFN alone.45 Capobianchi et al. reported that there was little difference in thyroid autoantibody patterns between the two groups; however, patients AZD4547 concentration positive for thyroid autoantibodies in the combination treatment group frequently developed hypothyroidism.46 Nadeem et al. reported that few studies have investigated the role of RIB in autoimmune diseases, especially in thyroid autoimmune disorders. Furthermore, RIB is combined with IFN for treating chronic hepatitis C and never used alone. Therefore, the precise contribution of RIB to IFN-induced thyroid dysfunction in chronic hepatitis C cannot be fully understood.27 Taken together, the data suggest that, like PEG-IFN, RIB does not appear to increase the risk of developing or exacerbating thyroid disorders or UC. In Europe and the USA, IFN has been used to treat UC, and studies have demonstrated its effectiveness (Table 3).18–24 In contrast, only three studies have reported the effectiveness

of IFN for Crohn’s disease in Japan. In addition, MCE公司 several cases in which UC worsened have been reported (Tables 1,2) since Mitoro’s first report in 1993. Because IFN therapy may induce autoimmune diseases, including hypothyroidism, administering IFN to patients with autoimmune diseases is less popular in Japan. Only two cases in which IFN was effective for UC or Crohn’s disease in Japan have been reported. In Europe and the USA, IFN-β, but not IFN-α, is thought to be effective for IBD; however, IFN-α is considered safe to use when UC is in remission. Furthermore, the IBD exacerbation after IFN-α treatment initiation is thought to be acute. However, the idea that both IFN-α and β are treatment options for IBD is not mainstream in Japan. Since the development/exacerbation of UC associated with IFN-β has been reported, IFN-α has been accepted as a factor that causes or exacerbates IBD.