Researchers from Germany find no increased risk for interferon alpha-induced mental side effects in psychiatric patients, if interdisciplinary care and antidepressant treatment are available.

Psychiatric disorders or drug addiction are often regarded as contraindications against the use of interferon alpha (IFN-alpha) in patients with chronic hepatitis C.

In this study, a research team obtained prospective data on adherence to, efficacy, and mental side effects of treatment with IFN-alpha. They assessed different psychiatric risk groups and compared these with controls.

Their findings are published in the February issue of Hepatology.

The team included 81 patients with chronic hepatitis C and psychiatric disorders (n = 16), methadone substitution (n = 21), former drug addiction (n = 21), or controls without a psychiatric history or drug addiction (n = 23) in there study.

Study subjects were treated with a combination of IFN-alpah-2a 3 MU 3 times weekly and ribavirin (1000 to 1200 mg/d).

In the psychiatric group, more patients received antidepressants before and during treatment with interferon alpha.

The team found that sustained virologic response did not differ significantly between subgroups.

In addition, no significant differences between groups were detected with respect to IFN-alpha-related development of depressions during treatment.

The researchers found that, in the psychiatric group, significantly more patients received antidepressants before and during treatment with IFN-alpha.

However, none of the patients in the psychiatric group had to discontinue treatment because of psychiatric deterioration.

Overall, 43% of patients with former drug addiction dropped out of the study, compared with 18% in the psychiatric group, 14% in the methadone group, and 13% in the control group.

Dr Martin Schaefer's team concluded, "Our data do not confirm the supposed increased risk for IFN-alpha-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-alpha and ribavirin in an interdisciplinary setting."

Hepatology 2003; 37: 443-51 30 January 2003