Treating Hepatitis C in Patients With Schizophrenia
Treating Hepatitis C in Patients With Schizophrenia
A total of 5500 patients were recorded on the database, of whom three were excluded due to a diagnosis of drug-induced psychosis. Of 5497 patients, 64 (1.2%) had a diagnosis of schizophrenia. Patients were predominantly male (83%) with a mean age of 36 ± 7.8 years. Baseline characteristics of PWS and controls were similar (Table 1), with the exception of higher rates of current or former intravenous drug use, prior alcohol excess and cirrhosis. A total of 1700 patients were treated, with PWS as likely to undergo treatment as controls [28/61(46%) vs 1639/4415 (37%), P = 0.19]. Amongst treated patients (Table 2), PWS were older [mean 46 ± 7.4 vs 37 ± 7.2 P < 0.01] and more likely to be cirrhotic [9/28 (32%) vs 265/1639 (16%), P = 0.04].
9/28 (32%) of PWS undergoing HCV treatment received Olanzapine as treatment for their schizophrenia, with 18 patients on other treatments (four Quetiapine, four Amisulpride, four Risperidone, two Aripiprazole, two Zuclopenthixol, one Flupentixol and one unspecified depot treatment). Review of medical case notes was unable to identify psychiatric medication in one patient.
A total of 192 patients (three PWS and 189 controls) not yet 6 months posttreatment were excluded from treatment outcome analysis. Overall SVR rates were higher in PWS [21/25 (84%) vs 788/1453 (54%), P < 0.01], analysis per genotype showed similar SVR rates amongst genotype 1[4/8 (50%) vs 239/684 (35%) P = 0.56) and genotype 2/3 infected patients [17/17 (100%) vs 599/742 (81%) P = 0.09). Treatment discontinuation due to adverse events (Table 3) was similar [2/25 (8%) vs 189/1453 (13%), P = 0.66], with no difference in discontinuation due to depression [1/25 (4%) vs 27/1453 (1.8%), P = 0.95]. No patient discontinued treatment due to worsening schizophrenia. No PWS discontinued therapy due to noncompliance (0/25 (0%) vs 72/1453 (5%), P = 0.49).
PWS took longer from referral to treatment [1217 (609–2025) vs 535 (278–1315) days, P < 0.01]. A minority of both PWS and controls commenced treatment within 1 year of referral [4/28 (14%) vs 534/1639 (32%) P = 0.06]. Comparing the first and last 3 years of the study, referral to treatment times fell amongst both PWS (2990 (1186–4794) vs 605 (185–902), P = 0.08) and controls (746 (429–1333) vs 262 (167–445), P < 0.01). In the last 3 years studied, referral to treatment time was not significantly longer amongst PWS (605 (185–902) vs 262 (167–445), P = 0.23).
Patient factors (poor attendance, unstable drug and alcohol use, unstable schizophrenia, significant co-morbidities) accounted for the majority of delays in progressing to treatment amongst PWS (21/25, 84%). Delays in receiving psychiatric assessment were uncommon [2/25 (8%)]. Two patients initially not offered treatment (one due to mild disease and one receiving Clozapine) were subsequently treated on follow-up.
Results
A total of 5500 patients were recorded on the database, of whom three were excluded due to a diagnosis of drug-induced psychosis. Of 5497 patients, 64 (1.2%) had a diagnosis of schizophrenia. Patients were predominantly male (83%) with a mean age of 36 ± 7.8 years. Baseline characteristics of PWS and controls were similar (Table 1), with the exception of higher rates of current or former intravenous drug use, prior alcohol excess and cirrhosis. A total of 1700 patients were treated, with PWS as likely to undergo treatment as controls [28/61(46%) vs 1639/4415 (37%), P = 0.19]. Amongst treated patients (Table 2), PWS were older [mean 46 ± 7.4 vs 37 ± 7.2 P < 0.01] and more likely to be cirrhotic [9/28 (32%) vs 265/1639 (16%), P = 0.04].
9/28 (32%) of PWS undergoing HCV treatment received Olanzapine as treatment for their schizophrenia, with 18 patients on other treatments (four Quetiapine, four Amisulpride, four Risperidone, two Aripiprazole, two Zuclopenthixol, one Flupentixol and one unspecified depot treatment). Review of medical case notes was unable to identify psychiatric medication in one patient.
A total of 192 patients (three PWS and 189 controls) not yet 6 months posttreatment were excluded from treatment outcome analysis. Overall SVR rates were higher in PWS [21/25 (84%) vs 788/1453 (54%), P < 0.01], analysis per genotype showed similar SVR rates amongst genotype 1[4/8 (50%) vs 239/684 (35%) P = 0.56) and genotype 2/3 infected patients [17/17 (100%) vs 599/742 (81%) P = 0.09). Treatment discontinuation due to adverse events (Table 3) was similar [2/25 (8%) vs 189/1453 (13%), P = 0.66], with no difference in discontinuation due to depression [1/25 (4%) vs 27/1453 (1.8%), P = 0.95]. No patient discontinued treatment due to worsening schizophrenia. No PWS discontinued therapy due to noncompliance (0/25 (0%) vs 72/1453 (5%), P = 0.49).
PWS took longer from referral to treatment [1217 (609–2025) vs 535 (278–1315) days, P < 0.01]. A minority of both PWS and controls commenced treatment within 1 year of referral [4/28 (14%) vs 534/1639 (32%) P = 0.06]. Comparing the first and last 3 years of the study, referral to treatment times fell amongst both PWS (2990 (1186–4794) vs 605 (185–902), P = 0.08) and controls (746 (429–1333) vs 262 (167–445), P < 0.01). In the last 3 years studied, referral to treatment time was not significantly longer amongst PWS (605 (185–902) vs 262 (167–445), P = 0.23).
Patient factors (poor attendance, unstable drug and alcohol use, unstable schizophrenia, significant co-morbidities) accounted for the majority of delays in progressing to treatment amongst PWS (21/25, 84%). Delays in receiving psychiatric assessment were uncommon [2/25 (8%)]. Two patients initially not offered treatment (one due to mild disease and one receiving Clozapine) were subsequently treated on follow-up.
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