Pegylated interferon-α2b plus ribavirin therapy in patients with hepatitis C and psychiatric disorders: results of a cohort study

Background: Hepatitis C antiviral therapies have significant psychiatric side effects. It is therefore believed that they might exacerbate mental illness in patients with pre-existing psychiatric disorders, resulting in poor adherence and response to antiviral treatment. We aimed to assess adherence to treatment, virological outcomes and mental safety in psychiatric patients, compared with non-psychiatric patients, treated for hepatitis C. Methods: A cohort study involved unselected hepatitis C patients on scheduled therapy with pegylated interferon-α2b and ribavirin, between 2002 and 2005 in France, and followed-up until 6 months after the end of treatment. Virological response was reported by the physician according to standard definitions and adverse events were monitored. Adherence to treatment was assessed by patient report. Results: Among 1,860 patients, 403 (22%) had pre-existing psychiatric disorders, mostly depressive and anxiety disorders. Strict adherence was similar in psychiatric and non-psychiatric patients (35% versus 39%; P=0.20) as was the rate of sustained virological response (52% versus 51 %; P= 0 . 75 ). Conversely the rate of mental adverse events was higher in psychiatric patients (78% versus 57%; P<0.001 Baseline characteristics independently associated with the risk of later mental adverse events were history of depression, initial pegylated interferon-α2b dose and female gender. Conclusions: Antiviral therapy in hepatitis C patients with associated psychiatric disease appears as effective as in other patients but results in a higher rate of mental adverse events, emphasizing the need for close monitoring of these psychiatric patients.