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Review
, 27 (10), 575-81

Antidepressant Prophylaxis Reduces Depression Risk but Does Not Improve Sustained Virological Response in Hepatitis C Interferon Recipients Without Depression at Baseline: A Systematic Review and Meta-Analysis

Review

Antidepressant Prophylaxis Reduces Depression Risk but Does Not Improve Sustained Virological Response in Hepatitis C Interferon Recipients Without Depression at Baseline: A Systematic Review and Meta-Analysis

Awad Al-Omari et al. Can J Gastroenterol.

Abstract

Background: Depression complicates interferon-based hepatitis C virus (HCV) antiviral therapy in 10% to 40% of cases, and diminishes patient well-being and ability to complete a full course of therapy. As a consequence, the likelihood of achieving a sustained virological response (SVR [ie, permanent viral eradication]) is reduced.

Objective: To systematically review the evidence of whether pre-emptive antidepressant prophylaxis started before HCV antiviral initiation is beneficial.

Methods: Inclusion was restricted to randomized controlled trials in which prophylactic antidepressant therapy was started at least two weeks before the initiation of HCV antiviral treatment. Studies pertaining to patients with active or recent depressive symptoms before commencing HCV antiviral therapy were excluded. English language articles from 1946 to July 2012 were included. The MEDLINE, Embase and Cochrane Central databases were searched. Where possible, meta-analyses were conducted evaluating the effect of antidepressant prophylaxis on SVR and major depression as well as on Montgomery-Asberg Depression Rating Scale and Beck Depression Index scores at four, 12 and 24 weeks. The Cochrane Collaboration tool was used to assess bias risk.

Results: Six randomized clinical trials involving 522 patients met the inclusion criteria. Although the frequency of on-treatment clinical depression was decreased with antidepressant prophylaxis (risk ratio 0.60 [95% CI 0.38 to 0.93]; P=0.02; I2=24%), no benefit to SVR was identified (risk ratio 1.08 [95% CI 0.74 to 1.57]; P=0.69; I2=58%).

Conclusion: This practice is not justified to improve SVR in populations free of active depressive symptoms leading up to HCV antiviral therapy.

Figures

Figure 1)
Figure 1)
Flow diagram of included studies. Flow diagram of records identified by search of electronic databases (MEDLINE, Embase, Cochrane Central) and reference lists of selected studies filtered according to hepatitis C antiviral treatment and prophylactic antidepressant therapy. The search was limited to studies indexed between 1946 and July 2012. The electronic search strategy is detailed in Appendix 1. RCT Randomized clinical trial
Figure 2)
Figure 2)
Sustained virological response (SVR) rate. Forest plot of the SVR rate compared between recipients of prophylactic antidepressants and the placebo group
Figure 3)
Figure 3)
A Depression rate, all studies included. Forest plot of the depression risk compared between recipients of prophylactic antidepressants and the placebo group. Fixed- and random-effects analyses are represented. B Depression rate excluding directional outlier (18). Forest plot of the depression risk compared between recipients of prophylactic antidepressants and the placebo group excluding one outlying study (18). Fixed- and random-effects analyses are represented
Figure 4)
Figure 4)
A Montgomery-Asberg Depression Rating Scale (MADRS) results at four, 12 and 24 weeks. Forest plot of the mean difference in MADRS scores compared between recipients of prophylactic antidepressants and placebo group at four, eight and 12 weeks. B Beck Depression Inventory (BDI) score at four, 12 and 24 weeks. Forest plot of the mean difference in BDI scores compared between recipients of prophylactic antidepressants and placebo group at four, eight and 24 weeks

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