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

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.

Chronic Hepatitis C Virus Infection, Extrahepatic Disease and the Impact of New Direct-Acting Antivirals

“…A recent study demonstrated that treatment with DAAs not only targets the viral load effectively but also has a profound impact on the neuropsychiatric manifestations associated with HCV infection. The findings suggest that DAA therapy is associated with a lower risk of developing new cases of neuropsychological disorders compared to interferon-based regimens, particularly among treatment-naïve HCV patients [ 78 ].…”

Three Distinct Reporter Systems of Hepatitis E Virus and Their Utility as Drug Screening Platforms

“…A previous investigation documented that various forms of IFN inhibit the replication of HEV RNA [49]. However, due to its adverse effects such as bone marrow toxicity and neuropsychiatric impacts [48,50], the use of this drug in chronic HEV infections-which mainly affect immunocompromised patients with multiple underlying diseases and morbidities-may be a major concern. Although pegylated IFN has shown some success in a limited number of patients with chronic HEV infection [51,52], it carries a risk of acute rejection in transplant recipients and subsequent graft loss [53,54].…”