Psychiatric treatment considerations with direct acting antivirals in hepatitis C

Sockalingam, Sanjeev; Tseng, Alice; Giguère, Pierre; Wong, David

doi:10.1186/1471-230x-13-86

Cited by 22 publications

(22 citation statements)

References 75 publications

(79 reference statements)

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“…However, a contraindication of this regimen is depression since treatment with pegylated IFNα can induce neuropsychiatric side events, such as depression, in 25–40% of all patients undergoing IFNα therapy for HCV 5 7–12. Furthermore, according to Sockalingam et al , ‘HCV-infected patients with pre-existing psychiatric disorders may have an exacerbation of a secondary psychopathology related to IFNα’,13 and ‘the onset of suicidal ideation and suicide during HCV therapy in general population coincide with the onset of IFNα-induced neuropsychiatric symptoms (IFNα-D)’ 14 15. Nevertheless, no data regarding the prevalence of neuropsychiatric symptoms in patients with psychiatric risk are available.…”

Section: Introductionmentioning

confidence: 99%

New direct-acting antivirals for hepatitis C treatment and neuropsychiatric symptoms in psychiatric risk groups

et al. 2018

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ObjectivesThe new direct-acting antivirals (DAAs) have changed chronic hepatitis C virus (HCV) treatment perspectives by achieving success rates in all genotypes and by reducing the associated adverse effects in comparison to pegylated interferon α regimens. These adverse effects include depression, insomnia and suicidal intention, which make it difficult to treat psychiatric risk groups. The objectives of this study were to evaluate the neuropsychiatric symptoms during HCV treatment with DAAs in standard multidisciplinary clinical practice in psychiatric risk groups and to assess the risk factors associated with neuropsychiatric symptoms in this study population.MethodsA prospective cross-sectional study was performed of all consecutive patients with psychiatric risk and HCV infection who completed treatment with the new DAAs at the ambulatory care pharmacy. We recorded demographic and clinical data, neuropsychiatric symptoms, emergency consultations, admissions to the psychiatric unit and interventions to manage neuropsychiatric symptoms. Statistical analysis was used to assess the association between neuropsychiatric symptoms and clinical data.ResultsWe included 48 patients with psychiatric risk and detected 36 neuropsychiatric symptoms in 17 (35.4%) patients, with a mean of 0.75 neuropsychiatric symptoms per patient. However, no studied risk factors for developing neuropsychiatric symptoms were found in this population.ConclusionsWe found a moderate prevalence of neuropsychiatric symptoms in the psychiatric risk group. The neuropsychiatric symptoms more frequently reported were insomnia (17%), irritability (15%) and depression (13%). Neuropsychiatric symptoms in patients with psychiatric risk can occur during treatment with DAAs but less frequently than with pegylated interferon α regimens, and so is a safe treatment for these patients.

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Section: Introductionmentioning

confidence: 99%

New direct-acting antivirals for hepatitis C treatment and neuropsychiatric symptoms in psychiatric risk groups

et al. 2018

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“…43 Current clinical trials showed that other recently approved or approval awaiting -HCV NS5A inhibitors (daclatasvir, ledipasvir) or HCV NS5B polymerase inhibitors (sofosbuvir, deleobuvir) also lack adverse effects that could significantly deteriorate patients mental condition. 43,44 However, DAAs are highly active antivirals, they have a low barrier to resistance. Thus, a combined treatment with PEG-IFN and RBV is being recommended, making the overall efficacy still dependent on individual IFN sensitivity and adverse effects tolerance.…”

Section: Ifn and Daas Therapymentioning

confidence: 99%

“…43 However, DAAs do not pose neuropsychiatric risk directly; they may interact with psychotropic agents through P450 cytochrome and p-glycoprotein. 43,44 The contraindicated drugs list includes: midazolam, carbamazepine, pimozide and hypericum perforatum. Interactions between PIs and SSRIs or SNRIs may exacerbate adverse effect or decrease blood plasma concentrations.…”

Section: Ifn and Daas Therapymentioning

confidence: 99%

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The neuropsychiatric aspect of the HCV infection

Więdłocha¹,

Marcinowicz²,

Sokalla³

et al. 2017

Adv Clin Exp Med

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HCV infection is significantly more prevalent in the population of psychiatric patients, drug addicts and people tending to undertake risky sexual behaviors than in the general population. This article presents a spectrum of psychopathological symptoms and psychological dysfunctions, an outline of current theories on the neuropathology and psychiatric aspects of HCV infection treatment. The unspecific character of the psychopathological symptoms in the HCV infection makes the process of thorough diagnostics and adequate treatment difficult, thus the specific and characteristic features have been emphasized. The aim of this review is to shed light not only on the basic information concerning CNS pathology but also on the conclusions emerging from the studies of different authors, of various methodology, in diverse study groups and also to investigate current topics of research. The results of neuroimaging studies have been presented as well. Attention has also been dedicated separately to specific issues, like psychiatric aspects of co-infection with HCV and HIV viruses, the chronic fatigue in the course of HCV infection, the influence of substance use disorders and difficulties encountered during treatment with interferon. Undiagnosed psychiatric disorders, not only inevitably decrease the already rather low quality of life but also cause non-adherence with recommendations and medications regimes, contributing to a worse treatment outcome. Finally, the above disorders, when left untreated, result in higher rates of risk-taking behaviors among the infected, thus imposing a danger not only to patients themselves but also to the healthy population.

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“…However, the recent FDA approval of two new oral medications, bocepravir and telapravir termed direct-acting antiviral medications, have been shown to enhance treatment responses of patients with genotype I infection, as well as, those who have previously failed interferon-based treatment [62]. Both methadone and buprenorphine have been shown not to have significant drug interactions with these hepatitis C medications and so can be co-administered [63], although the presence of adverse events should continue to be monitored clinically since experience with these combinations in practice is quite limited to date. The approach to treatment of hepatitis C may soon change to the use of oral medications rather than a combination of interferon, an injected therapeutic and oral medications.…”

Section: Treatment Of Chronic Hepatitis C Infection and Methadone Or mentioning

confidence: 99%

Advancing Service Integration in Opioid Treatment Progams for the Care and Treatment of Hepatitis C Infection

Kresina¹,

Lubran²,

Clark³

et al. 2014

IJCM

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It is estimated that approximately 200 million people globally are infected with the hepatitis C virus and that roughly half of these people live in Asia. Without treatment, it is estimated that roughly twenty percent of those infected with hepatitis C virus progress to chronic liver disease, then subsequently, end-stage liver disease. Thus, access to hepatitis C testing and subsequent care and treatment of chronic hepatitis C infection are essential to address the global burden of disease. In the United States, the Center for Disease Control and Prevention estimates that 60% of new cases of hepatitis infection are due to injection drug use. Opioid Treatment Programs (OTP's) dispense methadone and buprenorphine under specific federal regulations to injection drug users diagnosed with opioid dependence. OTPs are developing comprehensive care and treatment model programs that integrate general medical and infectious disease-related medical care with substance abuse and mental health services. Integrating hepatitis care services and treatment in the substance abuse treatment settings foster access to care for patients with hepatitis C infection, many who otherwise would not receive needed care and treatment. This may serve as a national model for highly cost-efficient healthcare that has a measurable outcome of improved public health with reduced hepatitis C prevalence.

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Psychiatric treatment considerations with direct acting antivirals in hepatitis C

Cited by 22 publications

References 75 publications

New direct-acting antivirals for hepatitis C treatment and neuropsychiatric symptoms in psychiatric risk groups

New direct-acting antivirals for hepatitis C treatment and neuropsychiatric symptoms in psychiatric risk groups

The neuropsychiatric aspect of the HCV infection

Advancing Service Integration in Opioid Treatment Progams for the Care and Treatment of Hepatitis C Infection

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