Can Antidepressants Prevent Pegylated Interferon-α-Ribavirin-Associated Depression in Patients with Chronic Hepatitis C: Meta-Analysis of Randomized, Double-Blind, Placebo-Controlled TrialsReportar como inadecuado




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Background

Antidepressants are effective in treating interferon-α-ribavirin IFN-α-RBV-associated depression during or after treatment of chronic hepatitis C CHC. Whether antidepressant prophylaxis is necessary in this population remains under debate.

Methods

Comprehensive searches were performed in Medline, Embase, Cochrane Controlled Trials Register and PubMed. Reference lists were searched manually. The methodology was in accordance with the 2009 PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement.

Results

We identified six randomized, double-blind, placebo-controlled trials involving 522 CHC patients treated with pegylated PEG-IFN-α plus RBV. The antidepressants used were escitalopram, citalopram, and paroxetine, which are selective serotonin reuptake inhibitors SSRIs. The rates of depression 17.9% vs. 31.0%, P = 0.0005, and rescue therapy 27.4% vs. 42.7%, P<0.0001 in the SSRI group were significantly lower than those in the placebo group. The rate of sustained virological response SVR 56.8% vs. 50.0%, P = 0.60 and drug discontinuation 18.7% vs. 21.1%, P = 0.63 in the SSRI group did not differ significantly to those in the placebo group. In terms of safety, the incidence of muscle and joint pain 40.8% vs. 52.4%, P = 0.03 and respiratory problems 29.3% vs. 40.1%, P = 0.03 were lower, but the incidence of dizziness was significantly higher 22.3% vs. 10.2%, P = 0.001 in the SSRI group.

Conclusion

Prophylactic SSRI antidepressants can significantly reduce the incidence of PEG-IFN-α-RBV-associated depression in patients with CHC, with good safety and tolerability, without reduction of SVR.



Autor: Xin-Jiang Hou, Jing-Hang Xu, Jun Wang, Yan-Yan Yu

Fuente: http://plos.srce.hr/



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