Greater than six percent of Americans will develop posttraumatic stress disorder (PTSD) of their lifetime. This potentially chronic condition disrupts lives, and might result in or exacerbate existing health issues resembling depression, anxiety, eating disorders, and suicidal thoughts.

Despite the high prevalence of PTSD, the US Food and Drug Administration has only approved two medications to treat this condition-;sertraline and paroxetine-;and each have shown only limited effectiveness in reducing PTSD symptoms.

PTSD can also be common amongst military veterans; greater than 10 percent of US Department of Veterans Affairs (VA) patients experience these symptoms. Two years ago, researchers at Boston University School of Public Health (BUSPH) and the White River Junction Veterans Affairs Medical Center in Vermont began to analyze whether existing medications may improve PTSD symptoms, with funding from the National Institute of Mental Health.

During an initial exploratory evaluation amongst a national cohort of VA patients, the researchers unexpectedly found that several recent direct acting antiviral (DAA) medications used to treat hepatitis C virus infection were related to PTSD symptom improvement. The findings were published within the journal Biological Psychiatry.

Now, in a recent, follow-up study, the researchers have conducted a more rigorous evaluation to look at and compare the effectiveness of the previously identified DAAs in PTSD symptom improvement. Their recent evaluation suggests essentially the most promising DAA for prospective study as a possible medication for PTSD in patients without hepatitis C virus infection.

Published online ahead of print within the American Journal of Epidemiology, the brand new study found that the medication combination glecaprevir and pibrentasvir had the strongest association with PTSD symptom improvement among the many DAAs most prescribed within the VA.

Many individuals have PTSD, but there few effective pharmacologic treatments and limited drug development for PTSD. Existing effective treatments are mostly psychotherapy, and while they work well, there are also issues with them, including numerous treatment drop-out they usually’re time-intensive, so adding to the suite of treatment options for people is a high priority.”

Jaimie Gradus, co-principal investigator and study senior writer, associate professor of epidemiology at BUSPH

The researchers examined the identical national cohort of VA patients because the prior study, but narrowed the study group to incorporate only patients diagnosed with hepatitis C.

“There really has been numerous interest to find recent medications for PTSD in the sphere,” says co-principal investigator Brian Shiner, a psychiatrist and acting associate chief of staff for research on the White River Junction VA Medical Center, in addition to associate professor of psychiatry at Dartmouth University’s Geisel School of Medicine. “The concept to take a look at VA data in this fashion grew out of a conversation within the scientific literature between the VA PTSD Psychopharmacology Working Group and the National Institutes of Mental Health. Paula Schnurr from the National Center for PTSD connected Jaimie and I, and we were really fortunate to acquire funding to bring a team together to do that work.”

Using patient care data from VA medical records, Gradus, Shiner, and colleagues from the VA, BUSPH, Geisel, and Harvard Medical School studied 254 VA patients who were diagnosed with PTSD and hepatitis C between October 1999 and September 2019. The participants received one combination of FDA-approved hepatitis C medications, including glecaprevir and pibrentasvir (GLE/PIB); ledipasvir and sofosbuvir (LDV/SOF); or sofosbuvir and velpatasvir (SOF/VEL). The researchers monitored the patients’ symptoms for each PTSD and HCV between two clinical visits over 8 to 12 weeks.

After adjusting for variables that would potentially influence results-;resembling opioid prescription use, liver disease diagnoses, emergency department look after psychiatric crises-;the team found that the GLE/PIB medications were more strongly related to PTSD symptom improvement that the LDV/SOF and SOF/VEL treatments, consistent with their previous results.

“At BUSPH, we have now been working with our VA colleagues to take a look at PTSD symptom improvement in routine care using medical records for several years,” Gradus says. “The extent of improvement we see for GLE/PIB is impressive and over twice what we have now seen for paroxetine and sertraline. I feel we have now done one of the best we are able to with medical records data, a very important next step on this line of labor shall be a prospective placebo-controlled study in patients without hepatitis C virus infection.”

“We recently received funding from the Department of Defense to review GLE/PIB as a possible treatment for PTSD in a prospective randomized placebo-controlled trial,” Shiner says. He and Gradus shall be involved with the project, and Vince Watts of the White River Junction VA Medical Center will function principal investigator. “It would be several years until we see the outcomes, but it is a very exciting case where we used VA patient data to discover a possible treatment for PTSD, which is an important problem for veterans’ health. In this fashion, veterans have informed PTSD treatment development.”

Source:

Boston University School of Public Health

Journal reference:

Shiner, B., et al. (2022) Comparative Effectiveness of Direct-Acting Antivirals for Posttraumatic Stress Disorder in Veterans Affairs Patients With Hepatitis C Virus Infection. American Journal of Epidemiology. doi.org/10.1093/aje/kwac104.