Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin: Response and psychiatric side effects

Abstract

We investigated and compared the results of treating the chronic hepatitis C (HCV) infection of different groups of psychiatric-risk patients and controls with pegylated interferon alpha (pegIFN-␣) plus ribavirin. Seventy patients were prospectively screened for psychiatric disorders. Seventeen patients without psychiatric diseases or drug addiction (controls), 22 patients with psychiatric disorders, 18 patients who had received methadone substitution treatment and 13 patients who were former drug users were treated with pegIFN-␣ plus ribavirin. Sustained virological response (SVR), adherence, and psychiatric side effects (using the MontgomeryAsberg Depression Rating Scale and the Brief Psychiatric Rating Scale) in the groups were compared. An SVR was found in 58.6% of all patients: 58.8% of the controls, 50% of psychiatric patients, 72.2% of methadone patients, and 53.8% of former drug users. Methadone-substituted patients and former drug users had significantly higher dropout rates. Scores for neither depressive nor psychotic symptoms differed significantly between groups during treatment. However, the controls had lower pretreatment scores, followed by a significant higher increase to maximum scores. A stepwise logistic regression model showed that only genotype, not group (control, psychiatric, methadone, or former drug abuse), type of psychiatric diagnosis (affective disorder, personality disorder, or schizophrenic disorder), depression scores before and during treatment, change in depression score, antidepressive treatment, sex, or liver enzymes before treatment, was associated with SVR. Conclusion: In an interdisciplinary treatment setting psychiatric diseases and/or drug addiction did not negatively influence psychiatric tolerability of and antiviral response rate to HCV treatment with pegIFN-␣ and ribavirin. ( I t is estimated that 170 million people worldwide are infected with the hepatitis C virus (HCV). Although the prevalence in the general population ranges between 1% and 2.4%, 1,2 the prevalence of HCV infection in patients with a chronic psychiatric disorder has been found to be significantly higher-between 6.8% and 8.5%. 3,4 Moreover, between 60% and 98% of intravenous drug users are chronically infected with HCV. [5][6][7] Interferon alpha (IFN-␣) is still the only effective treatment for chronic hepatitis C infection. In 1998, 2 studies showed that a combined regimen of IFN-␣ with ribavirin increased the sustained virological response (SVR) from 10% to 40%. 8,9 The development of pegylated interferons (pegIFN alpha-2a and pegIFN alpha-2b), characterized by a significantly longer half-life that allowed subcutaneous injection only once a week, further significantly improved therapeutic outcome when used in treatment in combination with ribavirin. 10-12 SVR rates between 51% and 82% have been reported, depending on the virus genotype. 10,11 Antiviral treatment of chronic hepatitis C with IFN-␣ is associated with several neuropsychiatric side effects such as fatigue, anhedonia, depression, irritab...

The neuropsychiatric aspect of the HCV infection

“…42 That study, as well as the more recent works by Scheafer et al, consistently shows that the HCV genotype is the only correlate of the SVR value. 42 There are several mechanisms that are being considered as relevant to the occurrence of IFN treatment adverse reactions. It remains unclear which are most significant in the pathophysiology.…”

“…There were no significant discrepancies regarding SVR between study groups and the control population. 42 What is more, no significant differences emerged while taking into account the occurrence and severity of first-time psychiatric conditions during therapy. The symptoms of depression present before or during treatment were statistically without any relation to the treatment outcome.…”

“…Schaefer et al conducted a study on 81 HCV-positive patients who were treated with IFNα-2a. 42 Current and previous psychiatric disorders, substance use disorders and methadone substitution were taken into account. There were no significant discrepancies regarding SVR between study groups and the control population.…”

Diagnosis, treatment, and follow-up of hepatitis C virus related liver disease.Hungarian national consensus guideline

“…A kezelés megfelel az előzőekben leírtaknak. [47,48] • A kábítószer-használók körében világszerte növekszik a HCV-fertőzöttek száma. Felkutatásuk és eredmé-nyes kezelésük egyéni és társadalmi (epidemiológiai) szempontból egyaránt fontos.…”

Perspectives on the management of chronic hepatitis B and C

“…There may be an association between the duration of hepatitis C and depression. The potential mechanisms of depression in hepatitis C have been studied [20]. Three major hypotheses for depression in the disease have been proposed.…”