Paroxetine for the treatment of interferon‐α‐induced depression in chronic hepatitis C

Kraus, Michael R.; Schäfer, Arne; Faller, Hermann; Csef, Herbert; Scheurlen, Michael

doi:10.1046/j.1365-2036.2002.01265.x

Cited by 158 publications

(80 citation statements)

References 34 publications

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“…However, these conditions are often successfully managed with appropriate antidepressant therapy during antiviral treatment. 13,14 Half of our survey population had never experienced antiviral therapy; women predominated in this group, as compared with the treatment-experienced group. Responses from those actively considering treatment were strikingly similar to the ratings given by those who had been on treatment.…”

Section: Discussionmentioning

confidence: 99%

Now, later or never? Challenges associated with hepatitis C treatment

McNally

Temple-Smith

Sievert

et al. 2006

Australian and New Zealand Journal of Public Health

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Section: Discussionmentioning

confidence: 99%

Now, later or never? Challenges associated with hepatitis C treatment

McNally

Temple-Smith

Sievert

et al. 2006

Australian and New Zealand Journal of Public Health

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“…Fortunately, most episodes of depression remain mild to moderate in severity and can be managed by the use of specific antidepressants, particularly members of the selective serotonin reuptake inhibitor class. 57,58 Judicious use of serotonin reuptake inhibitors with attention to the potential for additional side effects may help minimize dose reductions and discontinuations of antiviral therapy. 59,60 A recent study evaluated the use of prophylactic paroxetine for patients with melanoma undergoing high-dose interferon therapy.…”

Section: Management Of Specific Adverse Eventsmentioning

confidence: 99%

Side effects of therapy of hepatitis C and their management

2002

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Interferon and ribavirin combination therapy for chronic hepatitis C produces a number of well-described side effects that are dominated by fatigue, influenza-like symptoms, hematologic abnormalities, and neuropsychiatric symptoms. Combination therapy with pegylated interferons (peginterferon alfa-2a and alfa-2b) yields an adverse event profile similar to standard interferon, although the frequency of certain adverse events may vary by preparation. Premature withdrawal from therapy due to adverse events was required in 10% to 14% of participants in registration trials of these agents. Most adverse events were safely and effectively managed by dose reduction using predetermined criteria. The most common indications for dose reduction were hematologic abnormalities, such as anemia and neutropenia, with the latter more frequent in peginterferon treatment arms. Recent data suggest that maintaining adherence to a prescribed treatment regimen can enhance antiviral response. Strategies to maximize adherence are being developed and, in the future, may include early identification of and therapy for depression and the selective use of hematopoietic growth factors to ameliorate hematologic abnormalities. (HEPATOLOGY 2002;36: S237-S244.)T he side effect profile of combination therapy using standard interferon and ribavirin has been well described. [1][2][3][4] The major types of side effects include fatigue, influenza-like symptoms, gastrointestinal disturbances, neuropsychiatric symptoms, and hematologic abnormalities. 1,2 These side effects may be treatment limiting and require dose reduction or drug discontinuation. 3,4 Numerous other side effects occur with lower frequencies but may still have an impact on the tolerability of antiviral therapy. 2 Pegylated interferons (peginterferon alfa-2a and peginterferon alfa-2b) have significantly improved pharmacokinetics, 5-8 resulting in improved antiviral efficacy, which also has the potential to alter the side effect profile. This review will focus on the frequency and management of side effects reported with the use of peginterferon and ribavirin for the treatment of chronic hepatitis C based on data from 2 large registration trials that compared these agents with standard interferon and ribavirin combination therapy. Peginterferon Alfa-2a and RibavirinDiscontinuations and Dose Modification. The results of a large phase III clinical trial of peginterferon alfa-2a and ribavirin have been reported recently. 8 More than 1,100 subjects were randomized to therapy with peginterferon alfa-2a and ribavirin, peginterferon alfa-2a and placebo, or standard interferon alfa-2b and ribavirin. Premature withdrawal from therapy due to laboratory abnormalities or adverse events in the combination arms with either peginterferon (10%) or standard interferon (11%) was comparable 8 (Table 1). Interestingly, this rate of discontinuation for either combination arm was lower than previously reported in earlier trials using standard interferon and ribavirin (approximately 20%), 4,9 suggesting improv...

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“…35 Kraus et al demonstrated in a randomised, placebo-controlled trial, that 20 mg citalopram daily was significantly superior to placebo in reducing interferon-related depressive symptoms after 2 and 4 weeks. 92 A significant improvement in major depression was found in interferon-treated HCV patients managed concomitantly with 20 mg paroxetine, 93 allowing 79% of the subjects who had developed depression to complete interferon treatment. Certainly, SSRI use in chronic HCV patients does not appear to have any additional adverse effects in most case series and trials.…”

mentioning

confidence: 99%

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

Mullish

Kabir

Thursz

et al. 2014

Aliment Pharmacol Ther

107

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SummaryBackgroundThe scale of depression in patients with chronic liver disease (CLD) and those who have received orthotopic liver transplantation (OLT) is poorly characterised. Clinicians are uncertain of how best to manage depression within these patients.AimsTo review the literature evaluating both the prevalence and impact of depression in patients with CLD and post‐OLT, and to assess the safety and efficacy of antidepressant use within this context.MethodsA PubMed search using the phrases ‘chronic liver disease’, ‘cirrhosis’, ‘liver transplantation’, ‘depression’, ‘antidepressant’ and the names of specific causes of liver disease and individual antidepressants.ResultsOver 30% of cirrhotic patients have depressive features, and they experience worse clinical outcomes than nondepressed cirrhotic patients. CLD patients with chronic hepatitis C are particularly prone to depression, partly related to the use of interferon therapy. OLT patients with depression have higher mortality rates than nondepressed patients; appropriate antidepressant use reverses this effect. Selective serotonin reuptake inhibitors (SSRIs) and selective noradrenaline reuptake inhibitors (SNRIs) are effective and generally safe in both CLD and OLT patients.ConclusionsDepression is much more prevalent in CLD or OLT patients than is generally recognised, and it adversely affects clinical outcomes. The reasons for this relationship are complex and multifactorial. Antidepressants are effective in both CLD and post‐OLT, although lower doses or a reduced dosing frequency may be required to minimise side effects, e.g. exacerbation of hepatic encephalopathy. Further research is needed to establish optimal management of depression in these patients, including the potential role of nonpharmacological treatments.

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Paroxetine for the treatment of interferon‐α‐induced depression in chronic hepatitis C

Cited by 158 publications

References 34 publications

Now, later or never? Challenges associated with hepatitis C treatment

Now, later or never? Challenges associated with hepatitis C treatment

Side effects of therapy of hepatitis C and their management

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

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