Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin: Response and psychiatric side effects

Authors

  • Martin Schaefer,

    Corresponding author
    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
    2. Klinik für Psychiatrie, Psychotherapie und Suchtmedizin, Kliniken Essen-Mitte, Essen, Germany
    • Department of Psychiatry, Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany
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    • fax: (49) 0201-1742213

  • Axel Hinzpeter,

    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
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  • Ariane Mohmand,

    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
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  • Gesa Janssen,

    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
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  • Maurice Pich,

    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
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  • Markus Schwaiger,

    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
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  • Rahul Sarkar,

    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
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  • Astrid Friebe,

    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
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  • Andreas Heinz,

    1. Charité—Universitätsmedizin Berlin, Klinik und Poliklinik für Psychiatrie und Psychotherapie—Campus Charité Mitte, Berlin, Germany
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  • Michael Kluschke,

    1. Praxiszentrum Pannierstrasse, Suchttherapeutisches Zentrum, Berlin, Germany
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  • Marlene Ziemer,

    1. Praxiszentrum Pannierstrasse, Suchttherapeutisches Zentrum, Berlin, Germany
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  • Juri Gutsche,

    1. Praxiszentrum Pannierstrasse, Suchttherapeutisches Zentrum, Berlin, Germany
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  • Viola Weich,

    1. Charité—Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie—Campus Virchow Klinikum, Berlin, Germany
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  • Juliane Halangk,

    1. Charité—Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie—Campus Virchow Klinikum, Berlin, Germany
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  • Thomas Berg

    1. Charité—Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie—Campus Virchow Klinikum, Berlin, Germany
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  • Potential conflict of interest: Nothing to report.

Abstract

We investigated and compared the results of treating the chronic hepatitis C (HCV) infection of different groups of psychiatric-risk patients and controls with pegylated interferon alpha (pegIFN-α) plus ribavirin. Seventy patients were prospectively screened for psychiatric disorders. Seventeen patients without psychiatric diseases or drug addiction (controls), 22 patients with psychiatric disorders, 18 patients who had received methadone substitution treatment and 13 patients who were former drug users were treated with pegIFN-α plus ribavirin. Sustained virological response (SVR), adherence, and psychiatric side effects (using the Montgomery-Asberg Depression Rating Scale and the Brief Psychiatric Rating Scale) in the groups were compared. An SVR was found in 58.6% of all patients: 58.8% of the controls, 50% of psychiatric patients, 72.2% of methadone patients, and 53.8% of former drug users. Methadone-substituted patients and former drug users had significantly higher dropout rates. Scores for neither depressive nor psychotic symptoms differed significantly between groups during treatment. However, the controls had lower pretreatment scores, followed by a significant higher increase to maximum scores. A stepwise logistic regression model showed that only genotype, not group (control, psychiatric, methadone, or former drug abuse), type of psychiatric diagnosis (affective disorder, personality disorder, or schizophrenic disorder), depression scores before and during treatment, change in depression score, antidepressive treatment, sex, or liver enzymes before treatment, was associated with SVR. Conclusion: In an interdisciplinary treatment setting psychiatric diseases and/or drug addiction did not negatively influence psychiatric tolerability of and antiviral response rate to HCV treatment with pegIFN-α and ribavirin. (HEPATOLOGY 2007.)

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