What psychiatric screening and monitoring might be needed with the new generation of hepatitis C treatments?

Abstract

have emerged. These significantly boost the likelihood of sustained viral response, including for genotype 1, and do not seem to have the side effects of interferonalpha or ribavirin. Relevant data are reviewed to assess the degree that these new treatments might reduce the portion not eligible for treatment due to psychiatric comorbidities, and might reduce the emergence of psychiatric symptoms during treatment. Several organizations have recently released evidence-based treatment recommendation guidelines. It is apparent that interferon-alpha continues to be a standard of care, with the new drugs added to this recognized regimen in order to shorten treatment and to boost efficacy. Clinical settings must continue to assess appropriateness for treatment, including current or recent psychiatric comorbidities, and must continue to closely monitor patients for the emergence of psychiatric side effects. The newly developed hepatitis C treatments may affect the metabolism of several categories of psychiatric drugs, and so drug-drug interactions must also be considered and monitored. With many promising drugs under development, an all-pill regimen, with no interferon-alpha and no ribavirin, may emerge in the near future. This will greatly change the challenge of treatment decision-making, and should expand the portion of patients able to successfully complete a treatment regimen. Core tip: Emerging hepatitis C treatment regimens, which include newer medications such as boceprevir, telaprevir, sofosbuvir, and simeprevir, hold promise to reduce the need for psychosocial screening and monitoring. Thus far, these medications do not seem to have the same psychiatric side effect profile as interferon-alpha. AbstractPsychiatric difficulties, including depression and alcohol use disorders, pose a challenge to treatment decisionmaking for chronic hepatitis C. This is especially made worse because interferon-alpha, as part of the standard of care, may exacerbate depressive symptoms and cause suicidal symptoms to appear. This requires a treatment setting that has the capacity to carry out psychiatric assessment and monitoring, and the capability to deliver patient education regarding these aspects of care. Psychiatric comorbidities create a challenging decisionmaking situation, especially since success rates for the most common hepatitis C genotype, genotype 1, hover around 40%. In recent years, new treatments MINIREVIEWSSubmit a

Direct-acting antiviral treatment in real world patients with hepatitis C not associated with psychiatric side effects: a prospective observational study

“…Psychiatric morbidity in patients with HCV infection is elevated and otherwise eligible patients have frequently not received treatment because of the fear of an exacerbation of psychiatric symptoms [ 4 , 7 – 9 ]. A few studies suggest psychiatric comorbidity and drug abuse to be risk factors for non-adherence and not attaining sustained viral response (SVR) [ 10 – 12 ], whereas several other studies have demonstrated similar rates of adherence and SVR in patients with HCV infection and psychiatric comorbidity (including drug abuse) [ 13 – 17 ].…”

“…The side effect profile of DAAs compared with previous HCV medications is reported to be less severe [ 26 ] and patient-reported outcomes (PROs) improved [ 27 , 28 ]. Although there are efficacy studies with DAAs that include patients with psychiatric comorbidity, [ 29 , 30 ], few studies have specifically addressed psychiatric symptoms in DAA treatment [ 7 , 13 ]. A recent retrospective study that excluded patients with substance abuse and prior IFN-based treatment found that symptoms of depression decreased after treatment with DAA.…”

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

“…US Food and Drug Administration (FDA) prescribing information for recent drugs, that are FDA approved, do not note psychiatric symptoms as recognised side effects 20. Clinical trial ‘data indicate that these no interferon-alpha/no ribavirin regimens are far more well tolerated by patients, do not seem to have notable psychiatric contraindications and the type of psychosocial assessment for these regimens are typical in medical care' 7…”