Does Cognitive Function Worsen during Retreatment of Chronic Hepatitis C with
Pegylated Interferon plus Ribavirin?
Treatment
of chronic hepatitis C with pegylated interferon plus ribavirin can cause or exacerbate
depression.
The effect of treatment on cognitive function are largely unknown, although there
are numerous anecdotal reports by patients of cognitive impairment during and
after therapy with pegylated interferon and ribavirin.
The
aim of the current study, published in the May 2007 issue of Hepatology, was to determine whether retreatment with pegylated interferon
plus ribavirin adversely impacts cognitive function in patients with chronic hepatitis
C.
Cognitive
function was prospectively assessed using a battery of 10 standardized neuropsychological
tests at weeks 0, 24, 48, and 72. Cognitive impairment was defined based upon
a global deficit score. The Beck Depression Inventory and Brief Symptom Inventory
were used to assess mood.
Results
The 57 subjects who completed 48 weeks of antiviral therapy reported
significant increases in difficulty concentrating, emotional distress, and symptoms
of depression, all of which improved after cessation of therapy (P <
0.0001).
However, the frequency of cognitive
impairment did not increase during the first 24 weeks of treatment in 177 patients
(34% versus 32%, P = 0.64), nor in the 57 patients who completed
48 weeks of treatment (P = 0.48).
Based
on their findings, the study authors concluded, “Retreatment of prior non-responders
with peginterferon and ribavirin was not associated with objective evidence of
cognitive impairment as measured by a comprehensive battery of neuropsychological tests.”
“The
lack of cognitive impairment is reassuring and suggests that self-reported symptoms
of cognitive dysfunction are more likely related to the systemic and psychiatric
side effects of antiviral treatment rather than measurable changes in cognition,”
they continued.
It
seems unlikely that this study will resolve the question of the possible adverse
effects on cognitive function of patients receiving the pegylated interferon plus
ribavirin; clearly, more research is needed in this area.
05/11/07
Reference R
J Fontana, L A Bieliauskas, K L Lindsay,and others (the HALT-C Trial Group). Cognitive function does not worsen
during pegylated interferon and ribavirin retreatment of chronic hepatitis C.
Hepatology 45(5): 1154-1163. May
2007.
