Neuropsychiatric disorders in chronic hepatitis C patients after receiving interferon or direct-acting antivirals: a nationwide cohort study

Yu Fang; Chung-Yu Chen; Hsien-Chung Yu; Pei-Chin Lin

doi:10.3389/fphar.2023.1191843

Neuropsychiatric disorders in chronic hepatitis C patients after receiving interferon or direct-acting antivirals: a nationwide cohort study

Front Pharmacol. 2023 Jul 19:14:1191843. doi: 10.3389/fphar.2023.1191843. eCollection 2023.

Authors

Yu Fang^{1

2}, Chung-Yu Chen^{1

3

4}, Hsien-Chung Yu^{5

6

7

8

9}, Pei-Chin Lin^{10

11}

Affiliations

¹ Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Department of Pharmacy, Pingtung Veterans General Hospital, Pingtung, Taiwan.
³ Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁵ Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁶ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁷ Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
⁸ Department of Business Management, Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
⁹ Department of Nursing, Meiho Institute of Technology, Ping-Tung, Taiwan.
¹⁰ Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
¹¹ School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.

Abstract

Background: Data on the neuropsychological outcomes after receiving direct-acting antivirals (DAAs) among chronic hepatitis C (CHC) patients have not been well-documented. Aim: This study aimed to evaluate the difference in incidence of neuropsychological disorders (NPDs) after treatment completion between CHC patients receiving interferon (IFN) therapy and DAA therapy. Methods: A nationwide retrospective cohort study was performed using Taiwan's National Health Insurance Research Database (NHIRD) between 2010 and 2018. CHC patients without pre-existing mental disorders were included and divided into the treatment (Tx)-naïve DAA group, retreatment (re-Tx) DAA group, and Tx-naïve IFN group based on their HCV therapy. Propensity score matching was used to balance baseline differences between groups. The primary outcome was the incidence of NPDs during 6 months after completion of therapy. Results: After one-to-one matching, there were 6,461 pairs of patients selected from the Tx-naïve DAA group and Tx-naïve IFN group and 3,792 pairs from the re-Tx DAA group and Tx-naïve IFN group. A lower incidence of NPDs was observed in the Tx-naïve DAA group than in the Tx-naïve IFN group (HR = 0.72, 95% CI = 0.55-0.94, and p = 0.017). The risk of NPDs did not differ between the re-Tx DAA group and the Tx-naïve IFN group (HR = 0.74, 95% CI: 0.52-1.05, and p = 0.092). Conclusion: DAA therapy was associated with lower risk of NPDs when compared with IFN therapy among Tx-naïve CHC patients in a 6-month period after treatment completion, especially among the patients less than 65 years, male gender, and cirrhosis.

Keywords: anxiety; depression; direct-acting antivirals; hepatitis C virus; neuropsychological disorders.

Grants and funding

This work was supported by Kaohsiung Veterans General Hospital (KSVGH110-166, VGHKS109-D03-2) and by a grant from the Kaohsiung Medical University (KMU-S109032). The authors are grateful to Kaohsiung Veterans General Hospital and Kaohsiung Medical University for providing administrative and funding support. This study was based in part on data from the NHIRD provided by the Bureau of National Health Insurance (BNHI) of the Ministry of Health and Welfare.