Adherence and mental side effects during HCV treatment with interferon alfa and ribavirin in psychiatric risk groups

Psychiatric disorders or drug addiction are often regarded as contraindications against the use of interferon alfa in patients with chronic hepatitis C. The objective of the current study was to obtain prospective data on adherence to as well as efficacy and mental side effects of treatment with interferon alfa in different psychiatric risk groups compared with controls.

In a prospective trial, 81 patients with chronic hepatitis C (positive hepatitis C virus [HCV] RNA and elevated alanine aminotransferase [ALT] level) and psychiatric disorders (n = 16), methadone substitution (n = 21), former drug addiction (n = 21), or controls without a psychiatric history or drug addiction (n = 23) were treated with a combination of interferon alfa 2a 3 (Roferon A) MU 3 times weekly and ribavirin (1,000-1,200 mg/d).

Sustained virologic response (overall, 37%) did not differ significantly between subgroups. No significant differences between groups were detected with respect to interferon alfa-related development of depressions during treatment.

However, in the psychiatric group, significantly more patients received antidepressants before and during treatment with interferon alfa (P < .001).

Most of those who dropped out of the study were patients with former drug addiction (43%; P = .04) compared with 14% in the methadone group, 13% in the control group, and 18% in the psychiatric group. No patient in the psychiatric group had to discontinue treatment because of psychiatric deterioration.

The researchers conclude that the data do not confirm the supposed increased risk for interferon alfa-induced mental side effects and dropouts in psychiatric patients if interdisciplinary care and antidepressant treatment are available.

Preexisting psychiatric disorders or present methadone substitution should no longer be regarded as contraindications to treatment of chronic hepatitis C with interferon alfa and ribavirin in an interdisciplinary setting.

Schaefer M, Schmidt F, Folwaczny C et al. Adherence and mental side effects during hepatitis C treatment with interferon alfa and ribavirin in psychiatric risk groups. Hepatology 37 (2): 443-451. February 2003.

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Comment

This is a rather small study and patients were treated in a specialised center with a close collaboration of psychiatrists and hepatologists. In a well-controlled setting treatment of patients with psychiatric disorders including the use of antidepressants upfront may be feasible, but this is more difficult to recommend on a larger scale in less prepared centers.

It has to be stressed that interferon is causing depression in 15-20% of patients and suicides or psychotic decompensations have been reported multiple times. In addition hepatitis C is not a rapidly progressing disease for the majority of patients so risk and the likelihood of benefit (genotype, viral load, age etc.) should be carefully balanced.