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.

In conclusion, our 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.

04/18/03

Reference
Martin Schaefer and others. 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.

from www.hivandhepatitis.com