AASLD: Schizophrenics and Drug Abusers Get Short Shrift in HCV Therapy

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AASLD: Schizophrenics and Drug Abusers Get Short Shrift in HCV Therapy

By Neil Osterweil, Senior Associate Editor, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. November 16, 2005

ReviewSAN FRANCISCO, Nov. 15 - Schizophrenics who are infected with chronic hepatitis C (HCV) often don't get interferon-based therapy because it's thought that the patients either won't comply or that treatment could make their psychiatric symptoms worse.

But, in fact, say researchers from the Oregon Health Sciences University in Portland, patients with schizophrenia and schizoaffective disorders are just as likely as controls to complete a standard 48-week course of therapy, and have sustained viral responses in roughly equal numbers.

"There's a feeling among hepatologists that schizophrenic patients already have a psychotic illness, and interferon rarely causes psychotic symptoms that could make them worse, but that wasn't the case," said Hauser, M.D., a professor of psychiatry, in an interview at the American Association for the Study of Liver Diseases meeting here.

"Our clinical experience has been that these patients get through interferon treatment without having a relapse, without having a worsening of their psychotic symptoms, and in a couple of patients their psychotic symptoms have improved," Dr. Hauser said.

He and colleagues presented results of a study of the records of nearly 300,000 veterans treated between 1998 and 2003 to determine whether people with schizophrenia and substance use disorders complete and respond to interferon therapy for HCV infection at rates comparable to those of controls.

They looked at a record of 8,836 patients with schizophrenia or schizoaffective disorder, 47% of whom also had a history of substance abuse; 39,922 substance abusers with no history of schizophrenia; and 244,605 controls from the same VA database.

They found that 30% of controls were tested for HCV, and of this group 5% were found to be infected, and 14% of those infected were treated with interferon.

Among the schizophrenic/schizoaffective groups, 59% were tested for HCV, 22% were found to have it, and 11% received interferon therapy. Among the substance abusers, 63% were tested, 27% had the infection, and 11% were treated for it with interferon.

Patients in the schizophrenia group who received treatment were significantly less likely than controls to complete 24 weeks of interferon (29% vs. 46%, odds ratio=0.5, P=0.001), but they were equally likely to complete 48 weeks of interferon (13% vs. 15%, OR=0.9, P=0.69).

An intent-to-treat analysis revealed that schizophrenic patients achieved a sustained viral response of 25%, not significantly different than that of controls, at 30% (OR=0.8, P=0.73). Substance abusers were significantly less likely than controls to complete either 24 weeks (35% vs. 46%, OR=0.6, P< 0.001) or 48 weeks (11% vs. 15%, OR=0.7, P=0.03) of interferon therapy.

As in the schizophrenic group, however, an intent-to-treat analysis showed that the substance use disorder group achieved sustained viral response at rates comparable with those of controls (24% vs. 30%, OR=0.7, P=0.24).

"In spite of completion rate differences, results indicate that individuals with schizophrenia and substance use disorders have similar sustained viral response rates as controls," the investigators concluded. "Therefore, HCV treatment is warranted for these groups."

Their findings suggest that mental-health care providers should be part of an integrated team caring for patients with chronic HCV and mental-health disorders, Dr. Hauser said.

"We shouldn't exclude these patients automatically just because they have a psychiatric illness," he added.

http://www.medpagetoday.com/InfectiousDisease/Hepatitis/tb/2158