The Efficacy and Safety of Treating Hepatitis C in Patients With a Diagnosis of Schizophrenia

M. Z. Mustafa; J. Schofield; P. R. Mills; M. Priest; R. Fox; S. Datta; J. Morris; E. H. Forrest; R. Gillespie; A. J. Stanley; S. T. Barclay

Disclosures

J Viral Hepat. 2014;21(7):e48-e51. 

In This Article

Abstract and Introduction

Abstract

SUMMARY. Treating chronic hepatitis C with pegylated interferon alpha may induce or exacerbate psychiatric illness including depression, mania and aggressive behaviour. There is limited data regarding treatment in the context of chronic schizophrenia. We sought to establish the safety and efficacy of treating patients with schizophrenia. Patient and treatment data, prospectively collected on the Scottish hepatitis C database, were analysed according to the presence or absence of a diagnosis of schizophrenia. Time from referral to treatment, and the proportion of patients commencing treatment in each group, was calculated. Outcomes including sustained viral response rates, reasons for treatment termination and adverse events were compared. Of 5497 patients, 64 (1.2%) had a diagnosis of schizophrenia. Patients with schizophrenia (PWS) were as likely to receive treatment as those without [28/61(46%) vs 1639/4415 (37%) P = 0.19]. Sustained viral response (SVR) rates were higher in PWS [21/25 (84%) vs 788/ 1453 (54%) P < 0.01]. SVR rates by genotype were similar [4/8 (50%) vs 239/684 (35%) Genotype 1 (P = 0.56), 17/17 (100%) vs 599/742 (81%) non-Genotype 1 (P = 0.09)]. Adverse events leading to cessation of treatment were comparable [2/25(8%) vs 189/1453 (13%) P: 0.66]. Patients with schizophrenia are good candidates for hepatitis C treatment, with equivalent SVR and treatment discontinuation rates to patients without schizophrenia.

Introduction

Chronic hepatitis C virus infection (HCV) is a significant public health problem in Scotland with an estimated 39 000, or 0.8% of the population, being afflicted.[1] Schizophrenia is a common psychiatric disorder with an estimated population prevalence of 0.5% in the United Kingdom.[2] Seroprevalence of HCV in severe mental illness (schizophrenia, bipolar disorder and major depression) has been shown to be as high as 19.6%.[3] Other studies have revealed HCV prevalence rates of 4.1% amongst patients with schizophrenia (PWS).[4]

Treating HCV with pegylated interferon alpha (IFNα) may induce or exacerbate psychiatric illness including depression, mania and aggressive behaviour.[5] Its use in patients with a history of severe psychiatric conditions is recommended only after appropriate psychiatric management.

The potential to exacerbate underlying psychiatric illness may deter clinicians from treating PWS. A US veteran's cohort study identified increasing age, substance abuse, major and minor depression, bipolar disorder and schizophrenia as independent predictors of nontreatment for HCV.[6] Despite this, limited data suggest that PWS treated with IFNα experience psychiatric symptoms at comparable rates to untreated controls.[7,8] Supporting this, sustained viral response rates have been shown to be similar[8] or better[9] amongst PWS compared to controls.

We sought to establish the safety and efficacy of treating PWS attending treatment centres in Greater Glasgow.

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