Clinical

HCV drug treatment feasible in patients with psychiatric history

Last Updated: 2007-11-08 15:41:41 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Interferon-based therapy in patients with hepatitis C virus (HCV) infection may cause psychiatric symptoms and worsen symptoms in those with existing psychiatric conditions. However, with appropriate care, treatment for both groups of patients can be successful, researchers report in the November issue of the American Journal of Gastroenterology.

Interferon treatment is known to cause depression in about 20% of patients with no history of psychiatric disorders, Dr. Antoine Jakiche of the Albuquerque Veterans Affairs Medical Center, New Mexico, and colleagues point out. A previous study found that more than 85% of veterans with HCV infection also have a history of psychiatric disorder or substance abuse.

To further investigate the effects of interferon therapy, Dr. Jakiche's group studied 46 HCV-infected veterans with a psychiatric history and 33 without such a history. Both groups were treated with interferon-based therapy.

During treatment, the psychiatric group had minor fluctuations in depression scores compared with baseline. However, the non-psychiatric group had a significant increase in scores and were more likely to require additional treatment with antidepressants (63.6% versus 39.1%; p = 0.04).

They also required psychiatric drug treatment earlier than patients in the psychiatric group did (at 4.1 weeks versus 8.9 weeks; p = 0.01). Treatment resulted in a significant decrease in depression score in both groups, but scores continued to be higher than at baseline.

Forty-seven percent of all patients achieved a sustained viral response.

Commenting on the findings, Dr. Edward J. Bini, author of an accompanying editorial, told Reuters Health that the study "is an important contribution to the hepatology literature and provides additional evidence that hepatitis C virus-infected patients with stable psychiatric diseases can safely complete interferon and ribavirin therapy."

However, Dr. Bini of VA New York Harbor Healthcare System, New York, added that "care must be taken when selecting candidates for therapy because inappropriate treatment of patients with poorly controlled depression can be dangerous due to the risk of interferon-induced exacerbation of depression."

"Treatment," he concluded, "should be done in close collaboration with psychiatrists, substance abuse specialists, and other appropriate support staff."

Am J Gastroenterol 2007;102:2426-2436.