Good Response to Hepatitis C Treatment in Patients with a History of Psychiatric Conditions

By Liz Highleyman

Some prior studies have suggested that hepatitis C patients with a history of psychiatric conditions and substance use problems may experience more psychiatric side effects, especially depression, related to the use of interferon-based therapy. Thus, some clinicians have traditionally regarded such patients as “difficult to treat.”

Two recent studies, however, suggest that patients with a history of mental health conditions can be successfully treated for hepatitis C, achieving response rates similar to those of individuals without prior psychiatric diagnoses.

Study 1

In the first study, reported in the October 2007 issue of Hepatology, M. Schaefer and colleagues assessed treatment with pegylated interferon alpha plus ribavirin in 70 chronic hepatitis C patients with varying psychiatric histories:

·    22 with psychiatric disorders;

·    18 who had received methadone substitution therapy;

·    13 former drug users;

·    17 control subjects without prior psychiatric or addiction histories.

Results

·    The overall sustained virological response (SVR) rate was 58.6%:

o        50.0% for all patients with a psychiatric history;

o        53.8% for former drug users;

o        58.8% for control subjects;

o        72.2% for methadone recipients.

·    Overall, depression and psychotic symptom scores did not differ significantly between the groups during treatment.

·    However, the control subjects had lower pretreatment scores, and thus experienced a significantly higher increase to reach similar maximum scores.

·    Methadone recipients and former drug users had significantly higher treatment dropout rates.

·    In a stepwise logistic regression model, sustained response was not predicted by psychiatric history, past addiction, type of psychiatric diagnosis (affective disorder, personality disorder, or schizophrenic disorder), depression scores before or during treatment, change in depression score, or use of antidepressant drugs.

In conclusion, the authors wrote, “In an interdisciplinary treatment setting, psychiatric diseases and/or drug addiction did not negatively influence psychiatric tolerability of and antiviral response rate to HCV treatment with [pegylated interferon alpha] and ribavirin.”

Charité-Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie-Campus Charité Mitte, Berlin, Germany.

Study 2

In the second study, published in the November 2007 American Journal of Gastroenterology, A. Jakiche and colleagues looked at trends in depression and use of psychiatric medications among 79 chronic hepatitis C patients receiving interferon-based therapy at the Albuquerque Veterans Affairs Medical Center. More than half (58%) had a history of psychiatric conditions.

Clinical and psychiatric data were collected at baseline, at weeks 2, 4, 8, 12, and every 6 weeks thereafter. Depression was measured at each visit using the Center for Epidemiologic Studies-Depression (CES-D) scale.

Results

·    During interferon-based therapy, patients with a psychiatric history had minor fluctuations in depression scores compared with baseline.

·    Patients with no prior psychiatric diagnosis experienced a significant increase in depression scores, and were more likely to require the addition or increased dosing of antidepressant medications (63.6% vs 39.1%; P= 0.04).

·    The latter group also required sedatives or hypnotic drugs sooner (4.1 vs 8.9 weeks) after starting interferon (P= 0.01).

·    Increased use of antidepressants led to a significant decrease in depression scores in both groups at 4-6 weeks and 8-12 weeks, though they remained higher than baseline scores.

·    The overall SVR rate was 47.0%.

The study authors concluded that, “Hepatitis C patients with stable psychiatric history can be successfully treated with interferon-based therapy if followed closely by a multidisciplinary team that includes specialists in hepatitis C and behavioral health.”

Department of Medicine, Section of Gastroenterology, Albuquerque Veterans Affairs Medical Center, Albuquerque, NM.

12/11/07

References