Correspondence

Interferon Alfa–Induced Adverse Effects in Patients with a Psychiatric Diagnosis

N Engl J Med 2002; 347:148-149July 11, 2002

Article

To the Editor:

Two reports in the Journal 1,2 have suggested that patients who have psychopathologic symptoms before beginning interferon alfa therapy may have more severe adverse psychiatric effects in response to treatment. This suggestion was based on the observation that patients' scores on psychopathologic rating scales before interferon alfa therapy were positively correlated with the scores after four weeks of treatment.1,2 However, we and others have found that patients with a psychiatric diagnosis can successfully complete interferon alfa therapy.3,4 An editorial in the Journal has rightly emphasized that withholding interferon alfa inappropriately, especially from members of a stigmatized class, “raises questions about fairness and discrimination.”5

We evaluated 60 patients with chronic hepatitis B and C, some of whom had a preexisting psychiatric diagnosis, in Cagliari, Italy. They received 6 million to 10 million U of interferon alfa three times per week for 12 months. Information on the psychiatric diagnosis was obtained before therapy with the use of the non-patient structured clinical interview from the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised. Interferon alfa–induced adverse psychiatric effects were monitored monthly with use of the 17-item Hamilton Depression Rating Scale, the Beck Depression Inventory, and the Spielberger State–Trait Anxiety Inventory. We analyzed these results using response-feature analysis (maximal scores on psychopathologic rating scales during the therapy) and analysis of covariance. We compared the psychopathologic response of the 25 patients with a preexisting psychiatric diagnosis with that of the 35 patients with no psychiatric diagnosis, while adjusting for base-line differences (Table 1Table 1Scores on Psychopathologic Rating Scales at Base Line and during Interferon Alfa Therapy in Patients with a Preexisting Psychiatric Diagnosis and in Patients without Such a Diagnosis.). As expected, patients with a preexisting psychiatric diagnosis had higher base-line scores than patients with no psychiatric diagnosis (all P<0.01) (Table 1). After adjusting for the base-line values, we found no evidence that patients with a preexisting psychiatric diagnosis and patients with no psychiatric diagnosis had different maximal scores on the psychopathological rating scales (all P>0.5) (Table 1). We also found no significant difference between groups in the incidence of adverse psychiatric effects severe enough to require psychopharmacologic treatment: 3 of the 25 patients with a preexisting psychiatric diagnosis had such effects, as compared with 7 of the 35 patients with no psychiatric diagnosis (12 percent vs. 20 percent; chi-square with 1 df=0.22; P=0.6). We believe that patients who have psychopathologic symptoms before they begin taking interferon alfa should not be denied this effective therapy.

Carmine M. Pariante, M.D.
Sabine Landau, Ph.D.
King's College London, London SE5 8AF, United Kingdom
spjucmp@iop.kcl.ac.uk

Bernardo Carpiniello, M.D.
Institute of Clinical Psychiatry, 09127 Cagliari, Italy

for the Cagliari Group

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