2047. Interferon-induced Depression and Improved Treatment Response Rates in Patients with Hepatitis C
P Hauser, Portland VA Medical Center/Oregon Health & Science University, JM Loftis, Portland VA Medical Center/Oregon Health & Science University, AJ Whitehead, Portland VA Medical Center, J Hill, Baltimore VA Medical Center/University of Maryland School of Medicine, CD Howell, Baltimore VA Medical Center/University of Maryland School of Medicine, A Lewy, Oregon Health & Science University

Objectives: The objectives of the present study were to determine the association between IFN-induced depression and end-of-treatment response (ETR) and sustained viral response (SVR) rates and to investigate factors associated with increased ETR rates in patients who developed IFN-induced depression.

Methods: Thirty-nine patients with HCV were administered the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) and completed the Beck Depression Inventory (BDI) prior to starting IFN therapy.  Hepatitis C genotype and demographic information was obtained for all subjects including history of major depressive disorder (MDD), history of substance abuse, gender, race, and weight.  During the course of IFN therapy patients completed BDIs at least weekly, and those patients who became depressed were treated with citalopram, a selective serotonin reuptake inhibitor (SSRI) antidepressant.

Results:  Thirteen of 39 patients (33%) developed IFN-induced MDD.  Response rates were significantly higher in those patients who developed MDD than in those who did not (ETR: 61.5% or 8 of 13 vs. 26.9% or 7 of 26, 2 = 4.38, p = 0.03 and SVR: 38% or 5 of 13 vs. 11.5% or 3 of 26; 2 = 3.85, p = 0.04).  The total change in BDI score from baseline to peak value was significantly greater in subjects who responded to IFN therapy, regardless of whether or not they met the diagnostic criteria for MDD (t = 1.88, p = 0.034).  A one-way ANOVA to assess the effects of body weight on IFN response yielded a significant difference among the mean weights of patients undergoing IFN therapy (F = 3.19, p = 0.036).  Post hoc analyses revealed that men who did not respond to IFN therapy weighed more than men who did achieve ETR.  The association among other patient-related variables such as gender, race, history of MDD, and history of substance abuse with ETR was not significant.

Conclusions: Results indicate that: 1) IFN ETR and SVR rates were significantly higher in those patients who developed IFN-induced MDD than in those who did not; 2) male patients with ETR to IFN therapy were lighter in body weight than male patients who did not respond; and 3) gender, race, past history of MDD, and past history of substance abuse were not significantly associated with ETR.

Impact: Our results suggest that IFN-induced major depressive disorder may be a predictor of a positive response to IFN therapy, or an indication of optimal dosing.