The findings were published online recently in the American Journal of Epidemiology.
Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. The condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions.
PTSD is one of the most common psychiatric disorders, with an estimated lifetime prevalence of 6.4% in the United States. Yet only two drugs, the selective serotonin reuptake inhibitors sertraline (Zoloft) and paroxetine (Paxil), have been approved by the US Food and Drug Administration (FDA) to treat PTSD.
The combination of the two antiviral medications glecaprevir and pibrentasvir (Mavyret) is linked to improved symptoms in posttraumatic stress disorder (PTSD), new research suggests.
A national cohort study of US Department of Veterans Affairs patients included more than 250 participants with PTSD and comorbid hepatitis C virus.
Results showed the glecaprevir/pibrentasvir (GLE/PIB) combo was more strongly associated with PTSD symptom improvement than other antiviral combinations tested in the study, including ledipasvir/sofosbuvir.
“While there are great treatments available for PTSD, there’s a lot of desire in the field to find a new medication that will be helpful,” lead author Brian Shiner, MD, acting associate chief of staff for research, VA Medical Center, White River Junction, Vermont, told Medscape Medical News. “We had a great opportunity to use a novel data mining method to look in a wonderful database for a new treatment and we found something very promising,” said Shiner, who is also an associate professor of psychiatry at the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire.
The VA recommends trauma-based psychotherapy, such as prolonged exposure and cognitive processing therapy, as first-line treatments for PTSD. However, not all patents respond to or have access to these approaches, said Shiner.
The investigators wanted to examine whether existing medications might reduce PTSD symptoms. Their previous exploratory study used “data mining” of national VA medical records.
Results from that study showed the three hepatitis C antivirals of GLE (an NS3/4A protease inhibitor), PIB (a NS5A protein inhibitor), and velpatasvir (another NS5A protein inhibitor) were associated with more than double the expected number of patients experiencing a clinically meaningful improvement in PTSD symptoms. Sertraline was associated with only a slightly higher than expected improvement.
“SSRIs are effective, better than placebo, but the effects are not as good as we would hope,” Shiner said.
Shiner noted that GLE and PIB are always prescribed together (Mavyret), whereas velpatasvir is commonly prescribed with the NS5B polymerase inhibitor sofosbuvir under the brand name Epclusa. Sofosbuvir is also commonly prescribed with the NS5A protein inhibitor ledipasvir under the brand name Harvoni.