Impact of Pegylated Interferon Alfa-2b (Peg-Intron) and Ribavirin on Depression in Liver Transplant Recipients with Recurrent Hepatitis C

Side effects from treatment of recurrent hepatitis C (HCV) can be severe and lead to treatment discontinuation. The primary aim of this study was to assess the impact of antiviral therapy for recurrent HCV on depression in a cohort of liver transplant recipients using a validated depression scale.

Between September 2001 and October 2002, patients with recurrent HCV were treatment with pegylated interferon alfa-2b (Peg-Intron) and ribavirin (Rebetol) from Schering-Plough.

The Zung Depression Scale (ZDS) was used to assess depression and performed on all patients before and after treatment.

Patients were asked to rate 20 items according to how it applied to them at the time of testing by choosing one of the following four quantitative items that were graded on a scale between 1 and 4: a little of the time, some of the time, good part of the time and most of the time.

The range of scores was between 20 (0.25) and 80(1.0). Patients with higher scores had greater depressive illness than patients with lower scores.

Most people with depression score between 50 (0.63) and 69(0.86). The change in ZDS scores were calculated and a paired t test used to determine if there was a significant change in the pre-and post-treatment scores (alpha level =0.05).

A 95% confidence interval was also calculated for the mean change in scores. Only patients who completed both pre- and post-treatment ZDS were included in the analysis.

Results

45 patients were screened of whom 39 were eligible for treatment. 19 patients have completed treatment, 3 remain on treatment and 17 patients were intolerant to treatment of whom depression was the cause for treatment discontinuation in only 1 of these 17 patients. 22 patients completed both pre-and post-treatment ZDS.

There were 19 males and three females with a median age of 50.4 years (range 36-70.9). After anti-viral therapy, ZDS scores increased an average of 3.61 with a standard deviation of 7.76.The 95% confidence interval for the mean change was 0.24-7.111.

ZDS scores after antiviral therapy were significantly higher than before treatment (p =0.036).

Conclusion

According to the authors, “Antiviral therapy for liver transplant recipients was associated with development of depression or worsening depression in this cohort of liver transplant recipients with recurrent HCV.”

“This group of patients may benefit from anti-depressants, although depression was an infrequent cause of treatment discontinuation in this small series.”

06/07/04

Reference
M Challis and others. Impact of Pegylated Interferon Alfa-2b and Ribavirin on Depression in Liver Transplant Recipients with Recurrent Hepatitis C. Abstract 1173 (poster). Digestive Disease Week. May 15-20, 2004. New Orleans, LA.