Does prophylactic antidepressant treatment boost interferon-alpha treatment completion in HCV?

Area of Science:

• Hepatology
• Psychiatry
• Pharmacology

Background:

• Depression is a common side effect of interferon-alpha treatment for hepatitis C, often leading to treatment discontinuation.
• Antidepressant treatment is initiated upon depression detection (rescue approach).
• Prophylactic antidepressant treatment is proposed as a superior strategy to manage depression and improve adherence.

Purpose of the Study:

• To prospectively evaluate if prophylactic antidepressant treatment boosts antiviral treatment completion in chronic hepatitis C patients.
• To compare treatment discontinuation rates between prophylactic and rescue antidepressant strategies.

Main Methods:

• A structured literature search identified trials of antidepressant prophylaxis in patients undergoing antiviral treatment for chronic hepatitis C.
• Included studies reported depression outcomes and reasons for treatment discontinuation.
• Data on total enrollees and discontinuations (excluding lack of antiviral response or medical side effects) were aggregated for prophylaxis and rescue arms.

Main Results:

• Twelve studies were included (10 controlled trials).
• Antiviral therapy discontinuation rates were similar: 11.9% (47/396) in the prophylaxis arms and 11.8% (45/380) in the rescue arms.
• Prophylaxis managed depression symptoms but did not increase treatment completion.

Conclusions:

• Antidepressant prophylaxis in hepatitis C treatment does not enhance antiviral therapy completion rates.
• The rescue strategy for depression is effective when indicated.
• While beneficial for symptom management, antidepressant prophylaxis should not be relied upon to improve treatment adherence.