Depression May Complicate Hepatitis C Therapy

Megan Brooks

April 21, 2011

April 21, 2011 (Baltimore, Maryland) — Roughly 40% of patients with hepatitis C virus (HCV) infection are nonadherent to their HCV medications, according to results of an observational study presented here at the International Conference on Viral Hepatitis (ICVH) 2011. The conference is sponsored jointly by the International Association of Physicians in AIDS Care; the Johns Hopkins School of Medicine's Office of Continuing Medical Education in Baltimore, Maryland; and the University of Bonn in Germany.

The study also suggests that identifying depression in HCV-infected patients, which is often brought on by interferon (IFN) therapy, and treating it can help boost adherence to therapy.

"Twenty to 40% of patients on interferon will get depressive symptoms, and then they are more apt to not adhere to their HCV medications," Mary Cassler, RPh, MBA, director of clinical development for advanced clinical sciences and research, Medco Health Solutions, Franklin Lakes, New Jersey, who presented her research at the conference, noted in a telephone interview with Medscape Medical News.

"Proactive" depression screening may be a valuable tool to improve treatment adherence in patients with HCV "and may lead itself to better outcomes," she added.

Comorbidity Complicates HCV Treatment

Studies have shown that patients with chronic HCV need to take least 80% of their medication to suppress the virus, or risk the development of medication resistance and disease progression.

Ms. Cassler used the Medco claims database to identify patients new to HCV therapies receiving IFN and ribavirin and to determine medication adherence rates and the effect of comorbid conditions —particularly HIV infection and depression.

Among 3607 HCV-infected patients identified, 1657 (45.9%) were being treated for depression, and 109 (3.0%) were coinfected with HIV. Of those with HIV infection, 66 (60.5%) also had depression.

Only about 60% of all patients were adherent to their HCV medications; the highest adherence rates were seen in patients receiving treatment for depression. HCV medication adherence rates were 61.5% among those with depression only, and 69.7% in those with depression and HIV infection. Adherence to HCV medication was defined as a medication possession ratio of 80% or greater.

These data highlight the value of identifying and appropriately treating HCV-infected patients with depression, Ms. Cassler said, particularly given the well-established link between IFN therapy and the onset of depressive symptoms.

A "Wake-Up Call"

Jose M. Zuniga, PhD, MPH, president and chief executive officer of the International Association of Physicians in AIDS Care, who was not involved in the study, said this study, "with its startling observation that 40% of HCV-infected patients did not achieve adherence levels consistent with viral suppression, should be a wake-up call to scale-up education of patients about the importance of adherence to prescribed doses of anti-HCV drugs, and of clinicians to learn about and utilize evidence-based adherence interventions."

The study was an internal view of Medco claims data and had no outside funding. Ms. Cassler is an employee of Medco, but has no other relevant disclosures. Dr. Zuniga has disclosed that he is a consultant to Bristol-Myers Squibb.

International Conference on Viral Hepatitis (ICVH) 2011: Oral Abstract 70921. Presented Monday, April 11, 2011.

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