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EVALUATION OF TETRAHYDROCANNABINOL-CONTAINING ORAL MEDICATIONS FOR HEPATITIS C VIRUS ANTIVIRAL SIDE EFFECT MANAGEMENT

C Costiniuk, C Cooper
The University of Ottawa, The Ottawa Hospital Division of Infectious Diseases, Ottawa, ON

Objectives: The systemic and cognitive side effects of hepatitis C virus (HCV) therapy may be incapacitating, necessitating dose reductions or abandonment of therapy. Tetrahydrocannabinol-containing oral medications (oTHC) have been shown to ameliorate chemotherapy-induced nausea and vomiting and the AIDS Wasting Syndrome. oTHC efficacy in HCV treatment side effect management is unknown.
METHODS: All patients who initiated interferon-ribavirin therapy at The Ottawa Hospital Viral Hepatitis Clinic between August 2003 and January 2006 were identified using a computerized database (SPSS 13.0). Baseline characteristics of all patients were compared between oTHC (Cesamet® and Marinol®) recipients and non-recipients. Treatment side effect response to oTHC was assessed by chi-square. Key therapeutic outcomes related to weight, interferon dose reduction and treatment outcomes were assessed by student’s t test or chi-square.
RESULTS: 25 of 191 patients initiated oTHC. 20% reported an adverse event related to oTHC use. Recipients were similar in characteristics to non-recipients aside from prior marijuana smoking history [24% versus 10%, p=0.04]. Median time to oTHC initiation was week 7. Common oTHC indications and outcomes are as follows:
                                    

Indication	N	Proportion of Patients	Subjective Improvement as per Patient Report
Anorexia	18	72%	12 (67%)
Nausea	8	32%	6 (75%)
Vomiting	3	12%	2 (67%)
Insomnia	2	8%	0 (0%)
Composite Indication	25	-	16 (64%)

 NB: some patients had multiple indications for oTHC
Median weight loss prior to oTHC initiation was 4.5 kg. A trend toward greater median weight loss was noted at weeks 2 (1.5 kg) and 4 (1.4 kg) in patients eventually initiating oTHC compared to those who did not (1.0 kg at each time point). Weight loss stabilized one month after oTHC initiation (median –0.5 kg additional loss). Interferon dose reductions were rare and did not differ by oTHC use (2/25 versus 8/166). The proportions of patients completing a full course of HCV therapy and achieving a sustained virological response were greater in oTHC recipients [78% vs 49%, p=0.02; and 79% vs 52%, p=0.07, respectively].
CONCLUSIONS: oTHC use is often effective in managing HCV treatment-related symptoms contributing to weight loss and may stabilize weight decline once initiated.

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