Management
of Depression During Hepatitis C Treatment with Interferon-based
Therapy
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| SUMMARY:
Development of depression is common overall in chronic
hepatitis C patients treated with interferon, but people
with less social support appear to be more susceptible,
according to a study reported in the December
2009 American Journal of Gastroenterology.
However, the researchers found, people with depression
had an equally good chance of achieving sustained response
to treatment. |
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By
Liz Highleyman
Donna
Evon from the University of North Carolina at Chapel Hill and
colleagues performed a study to determine the association between
patient characteristics and prevalence of depression before and
during interferon-based therapy,
and to evaluate the relationship between depression and treatment
outcomes.
This prospective study included data from nearly 400 participants
(191 African-American and 203 Caucasian) in the Virehep-C study,
which was designed to look at differences in treatment response,
especially disparities between white and black patients. Numerous
studies have shown that people of African descent do not respond
as well to interferon-based therapy, but the reasons for this
discrepancy are not clear.
Depression was defined as a score of > 23 on the Center for
Epidemiologic Studies Depression (CES-D) scale. Scores were obtained
before treatment, at weeks 4, 12, and 24 of treatment, and 24
weeks after completion of treatment (the same time frame as determination
of rapid, early, and sustained virological response). Social support
at baseline was measured using the Medical Outcomes Study (MOS)
Social Support Survey.
Results
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At
baseline, 47 participants (12%) had a CES-D scores > 23.
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In
a univariate analyses, several patient characteristics were
associated with baseline depression, including lower social
support scores (P < 0.0001). |
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Participants
with baseline depression were significantly more likely to
experience psychiatric adverse events during treatment or
start new antidepressant medications (45% vs 28%; P=0.02). |
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This
group was also more likely to discontinue treatment early
(38% vs 13%; P < 0.0001). |
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Sustained
virological response (SVR) rates, however, were similar in
patients with and without baseline depression (38% vs 40%).
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The
incidence of new-onset depression was 26% by week 24. |
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About
33% of patients started antidepressant medication. |
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None
of the participants attempted suicide. |
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In
a multivariate analysis, new-onset depression was significantly
associated with younger age (P = 0.04), lower social support
(P < 0.001), and reporting "feeling depressed, sad,
or blue" (P = 0.008). |
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Participants
who developed depression during treatment were also more likely
to experience psychiatric adverse events or begin antidepressants
(44% vs 23%; P < 0.001), but were less likely to prematurely
discontinue treatment (6% vs 15%; P = 0.02). |
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Again,
patients with new-onset depression during treatment had an
SVR rate comparable to that of participants without depression
(47% vs 38%). |
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There
were no differences in the frequency of baseline or new-onset
depression between African-American and Caucasian patients.
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"In this large prospective analysis, baseline and new-onset
depression were associated with patient characteristics and treatment
outcomes," the study authors concluded, "however, SVR
rates did not differ between depressed and non-depressed patients."
"The relationship of lower baseline social support with depressive
symptoms warrants further investigation," they recommended.
Division of Gastroenterology and Hepatology, University of
North Carolina at Chapel Hill, NC; Epidemiology Data Center, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh,
PA; Via Research, LLC, Princeton Junction, NJ; Division of Gastroenterology,
University of California, San Francisco, CA.
1/29/10
References
DM
Evon, D Ramcharran, SH Belle, and others. Prospective Analysis
of Depression During Peginterferon and Ribavirin Therapy of Chronic
Hepatitis C: Results of the Virahep-C Study. American Journal
of Gastroenterology 104(12): 2949-2958 (Abstract).
December 2009.
