Tricyclic Antidepressants May Reduce Cirrhosis Risk in Hepatitis C

liver cirrhosis
liver cirrhosis
Investigators sought to determine the effect of tricyclic antidepressants for fibrosis progression and on the development of hepatocellular carcinoma in patients with hepatitis C virus infection.

Patients with hepatitis C who take tricyclic antidepressants (TCAs) have decreased fibrosis progression and a lower risk of developing cirrhosis, according to results published in the Journal of Viral Hepatology.

These results indicate a potential new application for TCAs.

The study included data from the Electronically Retrieved Cohort of Hepatitis C Virus Infected Veterans. Participants were categorized by their use of TCAs, selective serotonin reuptake inhibitors (SSRIs), or no antidepressants.

Of the 128,201 eligible participants, 4% used TCAs, 43% used SSRIs, and 53% used no antidepressants. Compared with participants who used SSRIs, participants who used TCAs had lower rates of drug abuse (43% and 34%, respectively). In addition, only 32% of participants using TCAs reported alcohol abuse compared with 42% of participants using SSRIs.

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After adjusting for age, baseline Aspartate Aminotransferase Platelet Ratio Index score, diabetes, hypertension, alcohol use, drug abuse, and hepatitis C RNA levels, the researchers found that TCA use was associated with a decreased risk for cirrhosis (hazard ratio, 0.77; 95% CI, 0.60-0.99) and delayed time to development of cirrhosis. However, TCA use was not associated with decreased incident hepatocellular carcinoma.

A.A. Butt has disclosed receiving an investigator-initiated grant support (to the institution) from Merck and Gilead Sciences.


Chen JY, Ren Y, Yan P, Belina ME, Chung RT, Butt AA. Tricyclic antidepressant use and the risk of fibrosis progression in hepatitis C-infected persons: results from ERCHIVES [published online March 22, 2018]. J Viral Hepat. doi: 10.1111/jvh.12884