Silybin supplementation during HCV therapy with pegylated interferon-α plus ribavirin reduces depression and anxiety and increases work ability

Abstract

BackgroundHepatitis C virus infection and interferon treatment are often associated with anxiety, depressive symptoms and poor health-related quality of life.To evaluate the Silybin-vitamin E-phospholipids complex effect on work ability and whether health related factors (anxiety and depression) were associated with work ability in subjects with chronic hepatitis C treated with Pegylated-Interferon-α2b (Peg–IFN) and Ribavirin (RBV).MethodsThirty-one patients (Group A) with chronic hepatitis and other 31 subjects in Group B were recruited in a randomized, prospective, placebo controlled, double blind clinical trial. Group A received 1.5 mg/kg per week of Peg–IFN plus RBV and placebo, while Group B received the same dosage of Peg–IFN plus RBV plus association of Silybin 94 mg + vitamin E 30 mg + phospholipids 194 mg in pills for 12 months. All subjects underwent to laboratory exams and questionnaires to evaluate depression (Beck Depression Inventory - BDI), anxiety (State-trait anxiety inventory - STAI) and work ability (Work ability Index - WAI).ResultsThe comparison between group A and group B showed significant differences after 6 months in ALT (P < 0.001), and viremia (P < 0.05), after 12 months in ALT (P < 0.001), and AST (P < 0.001), at follow up in AST (P < 0.05), and ALT (P < 0.001). Significant difference were observed after 1 month in WAI (p < 0.001) and BDI (P < 0.05), after 6 months in WAI (P < 0.05) and STAI (P < 0.05), after 12 months and at follow up in WAI, STAI and BDI (p < 0.01).ConclusionsThe supplementation with Silybin-vitamin E -phospholipids complex increased work ability and reduced depression and anxiety in patients treated with Peg–IFN and RBV.Trial registration NCT01957319, First received: September 25, 2013. Last updated: September 30, 2013 (retrospectively registered).

Safety and toxicity of silymarin, the major constituent of milk thistle extract: An updated review

“…In another clinical study on these patients, they received PEGylated‐interferon alfa 2b and ribavirin and one supplement daily (contains 94‐mg silybin, vitamin E, and phospholipids) for 12 months. In this trial, no intense adverse effects were reported, although some symptoms such as weight loss, muscle pain, irritability, hyperglycemia, joint pain, and hypercholesterolemia were observed (Malaguarnera et al, ). As well as in another trial on these patients, 27 male and female patients (who were treated with ribavirin and interferon and still hepatitis C virus ribonucleic acids were detectable) received 20 mg/kg of intravenous silymarin for 14 or 21 days.…”

Hepatocellular carcinoma and the risk of occupational exposure

“…Lastly, the HCC risk factors in chronic HBV infection are different and the pathogenesis is characterized by the combined action of different alterations involving genetic, epigenetic and immunological factors [63][64][65][66][67][68][69][70][71] (Figure 1). …”

Job performance in chronic hepatitis C virus patients treated with pegylated interferon-α2b plus ribavirin: an observational study

“…In previous studies we observed that treatment with Peg-IFN and Ribavirin shows on increase in depression or irritable mood, in mental and physical fatigue severity, a decrease in attention, concentration and in memory activity [16,17]. The decrease of PWS in SVR and in ETR is associated with a reduction in both anxiety and depression status.…”

“…The impact of the HCV infection and antiviral therapy has been investigated in several studies [10,11,13,16,17]. Various endogenous inflammatory cytokines and exogenous cytokine-associated to depression and anxiety has been correlated with specific risk factors that may allow for potential preventive interventions.…”

“…Despite some advances in the treatment of HCV, interferon is still a component of therapy. To fully characterize the impact of HCV and the burden of disease progression, the negative effects of both HCV and IFN treatment on worker productivity and lifestyle impairment need to be understood [14][15][16][17]. Work plays an important role in the wellbeing for many HCV patients; in fact the level of satisfaction at work was often as a strong motivator of social status and for social contacts.…”