Just because hepatitis C patients have psychiatric disorders or receive methadone substitution treatment, does not mean that they should be denied treatment with interferon alfa and ribavirin.
Psychiatric disorders or drug addiction are often regarded as contraindications against the use of interferon alfa in patients with chronic hepatitis C.
A team of German researchers studied 81 patients with chronic hepatitis C, including 16 patients having psychiatric disorders, 21 undergoing methadone substitution and 21 having a drug addiction. Another 23 patients had no psychiatric or drug addiction history and served as the control group.
All of the participants were treated with a combination of interferon alfa and ribavirin. The overall sustained virologic response was 37 percent and did not differ significantly between subgroups, according to the researchers.
The researchers detected no significant differences between the groups with respect to depression related to the inteferon alfa treatment. However, in the psychiatric group, significantly more patients received antidepressants before and during treatment with interferon alfa.
Most of those who dropped out of the study were patients with former drug addiction (43%) 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 a deteriorating mental state.
The researchers said their findings showed no 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 IFN- and ribavirin in an interdisciplinary setting," concluded the researchers.
Other sources: Hepatology 2003;37:443-451