No increase in depression with low-dose maintenance peginterferon in prior non-responders with chronic hepatitis C

Abstract

Background: Peginterferon and ribavirin treatment of chronic hepatitis C (CHC) is frequently associated with dose-limiting neuropsychiatric toxicity. The purpose of this study is to determine whether prolonged administration of low-dose peginterferon-α2a is associated with an increase in the rate and severity of depression compared to untreated controls.

Methods: 129 non-responders to full-dose peginterferon and ribavirin treatment were randomized to low-dose maintenance treatment with peginterferon-α2a 90 μg/week or no treatment for 3.5 years. Depression was assessed using the Beck Depression Inventory (BDI-II) and the Composite International Diagnostic Interview (CIDI) at baseline and at 12, 24, 36, and 48 months. "Clinical depression" was defined as BDI-II ≥11 and/or meeting DSM-IV criteria for major depression on the CIDI. Serial cortisol and serotonin plasma concentrations were obtained in a subgroup of patients.

Results: Rates of clinical depression did not significantly differ over time or between treatment groups. Baseline clinical depression was the only significant predictor of clinical depression over time (p<0.001). Rates of clinical depression were also significantly higher in patients experiencing liver disease progression (p=0.016). Antidepressant use did not significantly differ between groups. Adjusted whole blood serotonin levels dropped significantly over time (p=0.04), but there was no group by time effect.

Limitations: Lack of significant group differences in antidepressant use does not completely preclude significant mood changes masked by antidepressants. Results may differ in treatment naïve CHC patients or in those receiving full-dose peginterferon.

Conclusions: Prolonged low-dose peginterferon-α2a treatment is not associated with an increase in the frequency or severity of clinical depression in prior non-responder patients with chronic hepatitis C.

Trial registration: ClinicalTrials.gov NCT00006164.

Copyright © 2010 Elsevier B.V. All rights reserved.

Figures

Figure 1

Percentage of patients with “clinical depression” over time. After controlling for baseline clinical depression (p

Figure 2. Adjusted serotonin levels overtime in peg interferon treated patients and untreated controls

Mean adjusted serotonin levels (nmol/L 103 platelets) +/− SE over time in the peginterferon treated and untreated control groups. After controlling for baseline serotonin levels (p<0.001), there was a significant drop in serotonin levels over time (p=0.04), but there were no significant differences in groups (p=0.40) or in the group by time interaction (p=0.96) using ANOVA modeling.