Efficacy and Safety of Escitalopram for Prevention of Depression Induced by Peg-Interferon in Hepatitis C Patients

Phase 2

Completed

Conditions: Major Depressive Disorder
Hepatitis C, Chronic

Interventions: Drug: Placebo
Drug: Escitalopram

Registration Number: NCT00166296

Lead Sponsor: Germans Trias i Pujol Hospital

Brief Summary: The purpose of this study is to determine whether the use of an antidepressant (escitalopram) can prevent depressive episodes that appear during the treatment with peg-interferon and ribavirin in patients with chronic hepatitis C.

Detailed Description: Chronic hepatitis C is a prevalent condition, and the main cause of chronic liver diseases, including cirrhosis and cancer. Nowadays, interferon-alfa in combination with ribavirin is the main treatment option for this condition. In the last years, interferon molecule has been modified in order to improve tolerance into pegylated interferon.

Interferon-alfa has been associated with a high prevalence of psychiatric side effects, especially major depression (up to 25% of the cases), which is one of the main concerns about using this treatment. In fact, major depression is one of the main reasons of treatment withdrawal and treatment failure.

Major depression induced by interferon-alfa can be successfully treated with antidepressants, but we don't know if antidepressants can also prevent the development of major depression, and if this can be a safe intervention. In the literature, there is only one controlled trial about this issue, in cancer patients, and some open studies in hepatitis C.

In order to evaluate the efficacy, and safety, of an antidepressant (escitalopram) for preventing peginterferon's induced depressive episodes in patients with chronic hepatitis C, we have designed this 14-weeks placebo-controlled, double-blind, randomized clinical trial. Study interventions will be started two weeks before peginterferon + ribavirin's treatment onset.

Subjects included in the study will be patients with chronic hepatitis C who are going to be treated with peginterferon-alfa2a + ribavirin, and without mental disorders requiring active psychotropic treatment.

The main variables studied will be the appearance of a major depressive episode, following Diagnostic \& Statistical Manual of Mental Disorders (DSM-IV) criteria, and the total score on the Montgomery-Asberg Depression Rating Scale, along three assessment points at 4, 8 and 12 weeks of treatment with interferon. There will also be a follow-up period of up to 6 months after treatment with interferon is completed.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 133

Inclusion Criteria

Patients with chronic hepatitis C who are going to initiate treatment with peginterferon alfa2a + ribavirin.
Age 18-65 years.
Signed informed consent.
If female, they are not in fertile period or they use barrier contraceptives.
Patients able to understand and fill written questionnaires.

Exclusion Criteria

Hepatic cirrhosis or carcinoma.
Less than 4000/mm3 leucocytes, or less than 70000/mm3 platelets.
Hemoglobin less than 11 g/dL (females) or 12 (males).
Any risk factor for hemolysis.
Comorbid severe medical conditions (kidney, immune system, lung, heart, thyroid, etc).
Baseline mental disorders that require antidepressants (depressive disorders and anxiety disorders).
Other baseline mental disorders (delirium, substance use disorders).
Mental disorders at any time (dementia, psychotic disorders, bipolar disorders.
Contraindications of escitalopram (hypersensibility, diabetes, patients using serotoninergic agents, drugs that enhance the risk of bleeding, or monoamineoxidase inhibitors -MAOIs-).

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo pill	Placebo	Placebo
Escitalopram	Escitalopram	Escitalopram, 15 mg/day

Primary Outcome Measures

Name	Time	Method
Number of Participants Who Developed a Major Depressive Episode According to Diagnostic & Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Criteria During the First 12 Weeks of Antiviral Treatment.	First three months of interferon treatment.	At least five of the symptoms have been present during the same 1-week period: depressed mood, loss of interest or pleasure, weight or appetite changes, insomnia, agitation or retardation, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate, recurrent thoughts of death. At least one of the symptoms is either depressed mood or loss of interest. Diagnoses were made by a trained psychiatrist who applied the mood disorders module from the Structured Clinical Interview for DSM-IV Axis I Disorders, non-patient edition (SCID-I/NP) at each study evaluation.
Number of Participants With Sustained Hepatitis C Viral Response (Negativization of Serum Hepatitis C Virus Ribonucleic Acid).	Six months after the end of interferon treatment	Number of participants with negativization of serum hepatitis C Virus Ribonucleic Acid (HCV RNA) 6 months after concluding antiviral therapy (sustained viral response). Negativization was defined as the absence of detectable levels of serum HCV RNA using a polymerase chain reaction.

Secondary Outcome Measures

Name	Time	Method
Total Score in the Depression Subscale of the Hospital Anxiety and Depression Scale.	12 weeks after interferon treatment onset	The Hospital Anxiety and Depression Scale (HADS) is 14-item scale, patient-administered, that allows two independent scores of depression and anxiety. It has been specially designed to apply in patients with comorbid medical conditions as it excludes somatic or vegetative symptoms from the depression subscale. We present data of de depression subscale. The seven-item Depression subscale yields a score of 0-21, with higher scores meaning higher levels of depressive symptoms.
Total Score in the Montgomery-Asberg Depression Rating Scale	12 weeks after interferon treatment onset	The MADRS is a 10-item scale, clinician-administered, which is sensitive to symptom change during antidepressant treatment. It has been frequently used to measure depressive symptoms during interferon-alpha therapy and exhibits improved internal consistency in patients with co-morbid medical conditions compared with other clinician-administered questionnaires. Items are rated on a scale of 0-6. Scores range from 0 to 60, higher scores meaning higher levels of depression.

Trial Locations

Locations (15): Fundacion Hospital Alcorcon
🇪🇸
Alcorcon, Spain
Hospital Puerta de Hierro
🇪🇸
Madrid, Spain
Hospital Nuestra Señora de Sonsoles
🇪🇸
Avila, Spain
Hospital Universitario de Salamanca
🇪🇸
Salamanca, Spain
Hospital Universitari Germans Trias i Pujol
🇪🇸
Badalona, Spain
Hospital del Mar
🇪🇸
Barcelona, Spain
Hospital Ramon y Cajal
🇪🇸
Madrid, Spain
Hospital Universitario La Paz
🇪🇸
Madrid, Spain
Hospital Parc Tauli
🇪🇸
Sabadell, Spain
Hospital Universitario La Princesa
🇪🇸
Madrid, Spain
Hospital Clínico Universitario
🇪🇸
Valencia, Spain
Hospital Consorci Sanitari de Terrassa
🇪🇸
Tarrasa, Spain
Hospital General Universitario
🇪🇸
Valencia, Spain
Hospital La Fe
🇪🇸
Valencia, Spain
Hospital Miguel Servet
🇪🇸
Zaragoza, Spain