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

Table 1 Study characteristics and discontinuation data: Antidepressant prophylaxis for interferon-alpha treatment of hepatitis C virus

Study	Leading exclusion criteria	Prophylactic	Medication	Randomized:	Blinded:	Follow-up point,	Discontinued/Total in Arm:2
		intervention	run-in period	Yes/No	Yes/No	in wk1	Prophylaxis	Rescue
Schaefer et al[12]	Psychiatric history, interferon treatment	Escitalopram	2 wk	Yes	Yes	24/48	2/90	3/91
Klein et al[13], Klein et al [14]4	Active psychiatric disorder in the recent six months	Citalopram	3 wk	Yes	Yes	12	3/29	1/30
de Knegt et al[15]	Current Axis I disorder or current psychiatric prescription	Escitalopram	2 wk	Yes	Yes	24	2/34	2/37
Morasco et al[16]	Recent 3 mo psychiatric disorder	Citalopram	2 wk	Yes	Yes	24	N/A3	N/A3
Diez-Quevedo et al[17]	Active psychiatric disorder in the recent two months	Escitalopram	2 wk	Yes	Yes	24/48	4/51	6/48
Liu et al[18]5	Alcohol use during treatment	Specific antidepressants not reported	Not reported	No	No	24/48	11/23	2/25
Neri et al[19]	Substantial psychiatric history, interferon treatment	Individual, family, and marriage counseling	N/A	Yes	No	24	14/106: 9/106 for lack of compliance, 5/ for psychiatric reasons	28/105: 11/105 for lack of compliance, 17/105 for psychiatric reasons
Gleason et al[20]	Depression not yet in remission	Escitalopram	4 wk	N/A	N/A	24/48	2/10	No control group
Morasco et al[21]	Active psychiatric disorder in recent six months	Citalopram	4 wk	Yes	Yes	24	3/13	3/15
Raison et al[22]	Psychiatric disorder or prescription within recent six months	Paroxetine	2 wk	Yes	Yes	24	0/18	6/18
Kraus et al[8]	Active substance abuse	Paroxetine or citalopram	3 wk	No		15	0/8	Not reported for control group of 9
Schaefer et al[23]	Current or recent psychiatric diagnosis or prescription	Citalopram	2 wk	N/A	N/A	24	0/14	0/11
						Totals:	47/396	45/380

¹If 24/48, then treatment period accorded to interferon alpha regimen according to genotype, typically 24 wk for genotypes 2 and 3, and 48 wk for genotypes 1 and 4;

²Denominator is total, including those lost to follow-up, who could have dropped out due to psychiatric reasons, and excludes those without this possibility, which would include the following: non-response to antiviral therapy, drop-out after randomization but before beginning antiviral therapy, or medical adverse events such as thrombocytopenia;

³Three of 39 altogether discontinued antiviral therapy, but study report did not distinguish between active treatment and placebo for medical or other discontinuations;

⁴2008 study was a trial design report, and 2012 was poster of initial results recently presented at a conference;

⁵Retrospective observational chart review study; analysis limited to the two of four study arms that constitute a prophylaxis vs rescue comparison; 19 of the 23 in the prophylaxis arm were already taking antidepressants and the remaining 3 were started prophylactically before starting antiviral therapy.

Table 2 For studies reporting discontinuation data, number discontinuing interferon-alpha therapy, and reason for discontinuation, summed across studies

Reason for discontinuation	Prophylactic arm	Rescue arm
Lost to follow-up	21	19
Psychiatric side effects	8	18
Non-adherence	11	14
Did not complete therapy	3	3
Noncompliant or loss to follow-up	0	6
Other side effects	0	4