A team from Minneapolis, USA analyzed the effect of pre-existing psychiatric conditions in veteran patients undergoing interferon-alpha (IFN-alpha) treatment, with respect to adverse events, compliance, and treatment response.
Thirty-three veterans with chronic hepatitis C were treated with IFN-alpha (5 million units three times weekly) for 6 months, followed by a tapering dose for an additional 6 months.
The researchers, from the Veterans Affairs Medical Center and University of Minnesota, determined psychiatric diagnoses, adverse events, and virological and biochemical responses to therapy.
58% of the patients with hepatitis C had documented psychiatric conditions before starting IFN-alpha therapy.
Of the patients with pre-existing psychiatric diagnoses, 68% developed major adverse events requiring intervention or discontinuation of therapy. In contrast, only 29% of patients without psychiatric diagnoses developed major adverse events.
|Proportion of patients that developed major neuropsychiatric side-effects:|
|Am J Gastroenterol|
In the psychiatric group, 32% developed major neuropsychiatric side- effects compared with 14% of patients in the non-psychiatric group.
Patients with and without psychiatric diagnoses had equivalent biochemical and virological responses to therapy. Overall, only 6% of all patients had a sustained virological response.
Researcher S. B. Ho said on behalf of the group, "Veterans with chronic hepatitis C and psychiatric diagnoses experienced a significantly greater number of major adverse events during treatment with IFN-alpha."
"Veteran patients with hepatitis C should be carefully screened for psychiatric conditions and may require more intensive monitoring during IFN-alpha therapy," it was concluded.
In an accompanying editorial Ramsey Cheung and Aijaz Ahmed commented, "The small sample size and vast heterogeneity of psychiatric disorders among the patients in this study make it difficult to extrapolate recommendations for HCV therapy in patients with psychiatric disorders."
"However, patients with pre-existing psychiatric disorders require closer follow-up than the average patient while receiving antiviral therapy," they concluded.