Interferon Gamma for Chronic Granulomatous Disease

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Abstract
The International Chronic Granulomatous Disease Cooperative Study Group recently reported (Feb. 21 issue)1 on the efficacy of interferon gamma in preventing serious infections in patients with chronic granulomatous disease. The clinical benefit was shown in a year-long randomized, double-blind, placebo-controlled study of 128 patients. The frequency of infections in the placebo group, which received only prophylactic antibiotics, was higher than that in the treatment group, which also received interferon gamma (9.7 vs. 3.6 serious infections per 100 months). At our two centers in Paris and Zurich, however, cohorts of patients who received prophylaxis with the same antibiotic (trimethoprim–sulfamethoxazole) as in the cooperative study have a much lower frequency of infection (1.8 and 2.0 serious infections per 100 months in Paris and Zurich, respectively). Similarly, Weening et al. reported an incidence of 4.2 infections per 100 months in a study published in 1983.2 The frequency of infections at our centers was even lower than among the Cooperative Study Group patients1 who received interferon gamma in addition to prophylactic antibiotics ( Fig. 1 ). When we consider as an end point the time to the first serious infection (defined as requiring both hospitalization and the use of parenteral antibiotics), our conclusions are similar: the cumulative proportion of patients free of infection in the placebo group was 30 percent after one year, whereas in Paris and Zurich it was 88 percent and 80 percent, respectively, and after four years it was 54 percent and 55 percent. The pattern of inheritance of the disease should not account for these differences, because the proportions of X-linked and autosomal recessive chronic granulomatous disease were similar (41 and 24 patients, respectively, in the placebo group of the cooperative study, as compared with 24 and 9 among the 33 studied in Paris and 11 and 4 among the 15 studied in Zurich). The patients studied in Paris and Zurich were younger (median ages, 69 and 122 months, respectively) than in the placebo group of the cooperative study (mean age, 15 years), but younger age is not associated with a lower incidence of infections in chronic granulomatous disease.