Psychiatric side effects of pegylated interferon‑α and ribavirin therapy in Iranian patients with chronic hepatitis C: A meta‑analysis

Davoodi,Lotfollah; Masoum,Babak; Moosazadeh,Mahmood; Jafarpour,Hamed; Haghshenas,Mohammad   Reza; Mousavi,Tahoora

doi:10.3892/etm.2018.6255

Psychiatric side effects of pegylated interferon‑α and ribavirin therapy in Iranian patients with chronic hepatitis C: A meta‑analysis

Authors:
- Lotfollah Davoodi
- Babak Masoum
- Mahmood Moosazadeh
- Hamed Jafarpour
- Mohammad Reza Haghshenas
- Tahoora Mousavi
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Affiliations: Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari 48147‑88458, Iran, Psychiatry and Behavioral Sciences Research Center, Department of Psychiatry, Mazandaran University of Medical Sciences and Health Service, Sari 48147‑88458, Iran, Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari 48147‑88458, Iran, Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari 48147‑88458, Iran, Department of Microbiology, Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari 48147‑88458, Iran, Student Research Committee, Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari 48147‑88458, Iran
Published online on: June 6, 2018 https://doi.org/10.3892/etm.2018.6255
Pages: 971-978

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Abstract

An estimated 185 million people worldwide are infected with hepatitis C virus (HCV). Combination therapy with pegylated interferon‑α (peg IFN) and ribavirin is the first line of treatment against the psychiatric side effects, including mood disorders, anxiety and irritability. In the present study, all of the studies electronically published between 2000 and 2016 were retrieved using databases including Scopus, PubMed, Institute for Scientific Information, Science Direct and Google Scholar. All of the articles were independently evaluated by two reviewers and the results were compared, followed by removal of duplicate, irrelevant and re‑published studies after reviewing. The studies were assessed based on the heterogeneity of their results using the Cochrane test and I2 analysis. All groups included neuropsychiatric side effects, fatigue was reported at the highest rate in 60.41% [95% confidence interval (CI)=39.18‑81.64%] and insomnia was reported at a lower rate in 16.28% of cases (95% CI=6.59‑25.98%). In conclusion, the present meta‑analysis indicated that treatment with peg IFN + ribavirin or interferon only is associated with a wide range of neuropsychiatric side effects, including fatigue, mood disorders, anxiety, irritability, emotional ability and agitation.

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1	Shepard CW, Finelli L and Alter MJ: Global epidemiology of hepatitis C virus infection. Lancet Infect Dis. 5:558–567. 2005. View Article : Google Scholar : PubMed/NCBI
2	Wu JY, Shadbolt B, Teoh N, Blunn A, To C, Rodriguez-Morales I, Chitturi S, Kaye G, Rodrigo K and Farrell G: Influence of psychiatric diagnosis on treatment uptake and interferon side effects in patients with hepatitis C. J Gastroenterol Hepatol. 29:1258–1264. 2014. View Article : Google Scholar : PubMed/NCBI
3	Teoh NC, Farrell GC and Chan HL: Individualisation of antiviral therapy for chronic hepatitis C. J Gastroenterol Hepatol. 25:1206–1216. 2010. View Article : Google Scholar : PubMed/NCBI
4	Spennati A and Pariante CM: Withdrawing interferon-α from psychiatric patients: clinical care or unjustifiable stigma? Psychol Med. 43:1127–1132. 2013. View Article : Google Scholar : PubMed/NCBI
5	Hauser P, Morasco BJ, Linke A, Bjornson D, Ruimy S, Matthews A, Rifai A, Indest DW and Loftis JM: Antiviral completion rates and sustained viral response in hepatitis C patients with and without preexisting major depressive disorder. Psychosomatics. 50:500–505. 2009. View Article : Google Scholar : PubMed/NCBI
6	Fried MW, Shiffman ML, Reddy KR, Smith C, Marinos G, Gonçales FL Jr, Häussinger D, Diago M, Carosi G, Dhumeaux D, et al: Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. N Engl J Med. 347:975–982. 2002. View Article : Google Scholar : PubMed/NCBI
7	Manns MP, McHutchison JG, Gordon SC, Rustgi VK, Shiffman M, Reindollar R, Goodman ZD, Koury K, Ling M and Albrecht JK: Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomised trial. Lancet. 358:958–965. 2001. View Article : Google Scholar : PubMed/NCBI
8	Loftis JM and Hauser P: The phenomenology and treatment of interferon-induced depression. J Affect Disord. 82:175–190. 2004. View Article : Google Scholar : PubMed/NCBI
9	Asnis GM, de La Garza R II, Miller AH and Raison CL: Ribavirin may be an important factor in IFN-induced neuropsychiatric effects. J Clin Psychiatry. 65:581–582. 2004. View Article : Google Scholar : PubMed/NCBI
10	Asnis GM, de La Garza R, Rego SA, Henderson MA and Reinus JF: Interferon for hepatitis C patients with psychiatric disorders. Am J Psychiatry. 161:2332–2334. 2004. View Article : Google Scholar : PubMed/NCBI
11	Huckans M, Fuller B, Wheaton V, Jaehnert S, Ellis C, Kolessar M, Kriz D, Anderson JR, Berggren K, Olavarria H, et al: A longitudinal study evaluating the effects of interferon-alpha therapy on cognitive and psychiatric function in adults with chronic hepatitis C. J Psychosom Res. 78:184–192. 2015. View Article : Google Scholar : PubMed/NCBI
12	Masip M, Tuneu L, Pagès N, Torras X, Gallego A, Guardiola JM, Faus MJ and Mangues MA: Prevalence and detection of neuropsychiatric adverse effects during hepatitis C treatment. Int J Clin Pharm. 37:1143–1151. 2015. View Article : Google Scholar : PubMed/NCBI
13	Coman HG, HERŢA DC and Nemeş B: Psychiatric adverse effects of interferon therapy. Clujul Med. 86:318–320. 2013.PubMed/NCBI
14	Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC and Vandenbroucke JP: Iniciativa STROBE: The strengthening the reporting of observational studies in epidemiology [STROBE] statement: Guidelines for reporting observational studies. Gac Sanit. 22:144–150. 2008.(In Spanish). View Article : Google Scholar : PubMed/NCBI
15	Alavian SM, Kabir A, Hajarizadeh B, Nayebpour M, Dorodi T and Baralle FE: Preliminary report of interferon α2b in combination with ribavirin for 48 weeks for treatment of iranian patients with chronic hepatitis C: A quasi-experimental study. Shiraz E Med J. 7:1–8. 2006.
16	Alavian SM, Hajarizadeh B, Hajibeigi B, Doroudi T, Hamadanizadeh AK and Abar K: Efficacy and safety of pegylated interferon alfa-2a plus ribavirin for treatment of chronic hepatitis C and cirrhosis in Iranian. Hepat Mon. 4:53–58. 2004.
17	Alavian SM, Tabatabaei SV, Keshvari M, Behnava B, Miri SM, Elizee PK and Lankarani KB: Peginterferon alpha-2a and ribavirin treatment of patients with haemophilia and hepatitis C virus infection: A single-centre study of 367 cases. Liver Int. 30:1173–1180. 2010. View Article : Google Scholar : PubMed/NCBI
18	Alavian SM, Abolghasemi H, Miri SM, Keshvari M, Karimi Elizee P, Behnava B, Tabatabaei SV, Hajibeigi B and Lankarani KB: Safety and Efficacy of Pegylated Interferon Alfa-2a for the Treatment of Hepatitis C in Patients with Major Thalassemia. Iranian J Biood Cancer. 1:129–137. 2009.
19	Alavian SM, Ahmadzad M, Keshvari M, Behnava B and Hajibeigi B: Efficacy and safety of Interferon-alpha (Dferon B^®and Ribavirin combination therapy in patients with chronic hepatitis C in Iran. Hep Mon. 6:11–18. 2006.
20	Bafandeh Y, Saberi FM and BAGHERI LK: Evaluation of combination therapy with interferon and ribavirin in patients with chronic hepatitis C. A genotype based study. 2007
21	Forootan H, Sharifi A, Mirmomen SH, Daryani NE, Ghofrani H, Farahvash M, Nasiri M, Talebi M, Ghavidel A, Vosoghinia H, et al: A multicenter study to evaluate the safety and efficacy of heber on (interferon alfa-2b) in combination with ribavirin for the treatment of chronic hepatitis C in iran. Med J Islam Repub Iran. 19:7–12. 2005.
22	Jabbari H, Bayatian A, Sharifi AH, Zaer-Rezaee H, Fakharzadeh E, Asadi R, Zamini H, Shahzamani K, Merat S and Nassiri-Toosi M: Safety and efficacy of locally manufactured pegylated interferon in hepatitis C patients. Arch Iran Med. 13:306–312. 2010.PubMed/NCBI
23	Merat S, Sohrabpour AA, Khaleghi S, Sohrabi MR, Samimi-Rad K, Radmard AR and Malekzadeh R: Peginterferon alfa-2a and ribavirin in patients with chronic hepatitis C and inherited bleeding disorders. Hepat Mon. 4:59–64. 2004.
24	Mirmomen S, Ebrahimi Daryani N, Malekzadeh R, Zali MR, Haghpanah B, Poursamimi P, Hashemi S and Alavian SM: The efficacy and safety of peginterferon alpha-2a (PEGASYS) monotherapy in the treatment of chronic hepatitis C infected subjects with transfusion dependent thalassemia. Hepat Mon. 4:65–70. 2004.
25	Mirmomen S, Ghofrani H, Forootan Pishbuary H, Ebrahimi Daryani N, Jafar Farahvash M, Sharifian R, Azmodeh F and Malekzadeh R: Safety and efficacy of interferon alfa for the treatment of chronic hepatitis C infected subjects with transfusion dependent thalassemia in Iran. Med J Islam Repub Iran. 17:87–95. 2003.
26	Namazee N, Sali S, Asadi S, Shafiei M, Behnava B and Alavian SM: Real response to therapy in chronic hepatitis C virus patients: A study from iran. Hepat Mon. 12:e61512012. View Article : Google Scholar : PubMed/NCBI
27	Nasser Ebrahimi D, Babak H, AliReza S, Ali Asad H, Mohammad B, Parisa P and Nikbin M: The efficacy and side effects of therapy with peginterferon alpha-2 a (PEGASYS) combined with ribavirin in chronic hepatitis C patients: An open label clinical trial. Hepat Mon. 2004:71–74. 2004.
28	Pouresmaeeli M, Alavian SM, Keshvari M, Salimi S and Mehrnoush L: Efficacy and tolerability of peginterferon alpha-2a and peginterferon alpha-2b in Iranian patients with chronic hepatitis C. Hepat Mon. 15:e307802015. View Article : Google Scholar : PubMed/NCBI
29	Sandoughdaran S, Alavian SM, Sharafi H, Behnava B, Salimi S, Mehrnoush L, Karimi Elizee P and Keshvari M: Efficacy of prolonged treatment with pegylated interferon (Peg-IFN) and ribavirin in thalassemic patients with hepatitis C who relapsed after previous peg-IFN-based therapy. Hepat Mon. 15:e235642015. View Article : Google Scholar : PubMed/NCBI
30	Zali MR, Shalmani HM, Norouzinia M, Alizadeh AH, Nowroozi A and Berouz N: Peginterferon Alfa-2a (Pegasys) and Ribavirin in the treatment of chronic hepatitis C. Hepat Mon. 4:75–78. 2004.