Prophylactic use of selective serotonin reuptake inhibitors may significantly reduce the incidence of depression associated with pegylated interferon alfa-2a or 2b with ribavirin combination treatment for chronic hepatitis C, researchers from China reported.
Although pegylated interferon alfa-2a or alfa 2b (Peg-IFN a-2a or a-2b) with ribavirin is considered to be the most effective regimen for chronic hepatitis, the treatment is associated with “an approximately 70% incidence of mild to moderate depressive syndromes and 20% to 40% incidence of major depression” in patients with HCV infection, according to the researchers.
Yan-Yan Yu, MD, of the department of infectious diseases at Peking University, and colleagues conducted a meta-analysis of six randomized, double blind, placebo-controlled trials of 522 patients with chronic HCV who were treated with Peg-IFN a-2a or a-2b with RBV. Study participants in the selective serotonin reuptake inhibitor (SSRI) group received escitalopram (Lexapro, Forest Labs), citalopram (Celexa, Forest Labs) or paroxetine (Paxil, GlaxoSmithKline).
Results indicated that the rates of depression (17.9% vs. 31%; P=.0005) and rescue therapy (27.4% vs. 42.7%; P<.0001) in the SSRI group were significantly lower compared with rates in the control group. The sustained virological response (SVR) rate (56.8% vs. 50%; P=.60) and treatment discontinuation (18.7% vs. 21.1%; P=.63) did not differ significantly between groups. Although the incidence of muscle and joint pain (40.8% vs. 52.4%; P=.03) and respiratory problems (29.3% vs. 40.1%; P=.03) were lower in patients taking SSRIs, dizziness was significantly more common in this group (22.3% vs. 10.2%; P=.001).
The researchers said there were several study limitations, including unavailable data and small sample sizes in most of the trials.
Despite the limitations, Yu and colleagues wrote that prophylactic SSRI use can significantly reduce the incidence of depression associated with Peg-IFN a-2a or a-2b with ribavirin in patients with chronic HCV “with good safety and tolerability and without reduction of SVR.”
Disclosure: The researchers report no relevant financial disclosures.