Does Psychiatric lllness Affect Compliance, Ability to complete treatment or the Response to Treatment with Peginterferon Plus Ribavirin?

Many individuals with chronic hepatitis C also have psychiatric disorders. Unfortunately, interferon and ribavirin often intensify these unwanted effects, which may become so debilitating that discontinuation of therapy results.

In the current study, F Barakat  and colleagues at the University of California San Diego aimed to characterize the course of treatment among patients with psychiatric problems and to evaluate whether these patients can safely receive treatment with interferon plus ribavirin.

1300 consecutive pts with chronic hepatitis C (CHC) and psychiatric illness were considered for IFN based therapy. Of these, 271 pts had CHC alone + psychiatric illness. 108 were deemed psychiatrically stable for treatment. At the 56^th ICAAC, the investigators reported on 80 pts who completed a course of pegylated interferon and ribavirin therapy.

Results

• The mean age was 48.8 ± 6.5 years; 46% were male, 71% Caucasian, 15% African American, 5% Hispanic, and 9% other.
• 64% had depression, 17% had bipolar disorder, 9% had schizophrenia (Sz), and 10% had anxiety.
• All pts were on psychotropic medications and were clinically stable.
• Baseline median lab values showed: ALT of 65 (17-476) IU/L, AST of 50 (19-323) IU/L, Platelet count of 225 (54-390) 1000/mm3 and HCV viral load of 500,000 (7,810-3,590,000) IU/mL.
• 53% had none to moderate fibrosis on liver biopsy. 66% were Genotype 1. 73% successfully reached end of treatment (24 or 48 weeks based on genotype).
• 16% discontinued early due to exacerbation of psychiatric disorder (5/51 Depression, 6/14 Bipolar and 2/7 Sz), 7% due to drug related adverse events and 4% due to non-adherence.
• See table for virologic response. There were no significant differences between psychiatric diseases in terms of early discontinuation or treatment response (p=0.10 and 0.68, respectively).

In their conclusion, the study authors write, “Patients with pre-existing psychiatric illness tolerated treatment with pegylated interferon and ribavirin well, and the type of psychiatric illness did not affect the patient’s compliance, ability to complete treatment duration or response to treatment.”

                                                            Table

11/21/05

Reference
F Barakat and others. Combination Therapy Using Pegylated Interferon and Ribavirin in Patients with Psychiatric Illnesses. Abstract 1218. Abstracts of the 56^th annual meeting of the American Association for the Study of Liver Diseases. November 11-15, 2005. San Francisco, CA.