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Antidepressant prophylaxis failed to improve HCV treatment completion
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Prophylactic antidepressant use did not boost interferon-based treatment completion in patients with hepatitis C infection, according to the results of a recent literature review.
Depression rates associated with interferon-based therapy could be as high as 30%, which makes antidepressant prophylaxis an attractive proposition, but there is "no clear indication that the prophylactic strategy generally serves to boost treatment completion, compared to a monitor-and-rescue strategy," according to study researcher Paul J. Rowan, PhD, MPH, of the University of Texas Health Sciences Center at Houston School of Public Health.
The review included 12 studies of antidepressant prophylaxis for patients receiving interferon-alpha treatment for chronic HCV, including one retrospective chart review, one uncontrolled trial and 10 controlled trials.
Antidepressant treatment led to reduced depressive symptoms in patients with HCV, but results suggest that treatment discontinuation of antiviral therapy was not less common in patients taking antidepressants. Of the 396 patients who received antidepressants prophylactically, 11.9% discontinued treatment vs. 11.8% of patients who were part of a monitor-and-rescue strategy (n=380).
Sustained virologic response (SVR) to treatment among patients included in the review was comparable to other intervention studies using interferon-alpha combined with ribavirin, with an SVR of approximately 40% for patients with HCV genotype 1 and 75% for those with genotypes 2 and 3.
"Providers should be clear about desired purpose when considering prophylactic antidepressant for hepatitis C patients about to begin antiviral therapy," Rowan wrote. "Antidepressant prophylaxis does not seem to boost treatment completion, so other goals, such as managing depression, should be clarified when considering the strengths and weaknesses of this strategy. Discontinuation of interferon-alpha for chronic hepatitis C is a great treatment challenge, and anything that interferes with completion of treatment should be well investigated."
Disclosure: Rowan reports no relevant financial disclosures.
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