Elderly Patients Are at Greater Risk of Cytopenia During Antiviral Therapy for Hepatitis C

Since the last consensus conference on the management of chronic viral hepatitis, a number of studies looking at modifications of the standard course of treatment have been published. These changes have been sufficiently substantive to warrant review to determine whether any changes in the recommended treatment algorithms are needed. A consensus development conference was held in January 2007, and the present document highlights the results of the presentations and discussion about these issues. It reviews the epidemiology of hepatitis C in Canada, treatment of acute hepatitis C and new algorithms in chronic hepatitis C, including retreatment of previous treatment failures. In addition, sections on management of hepatitis C in special populations have been updated. There is also a section on the use of hematopoietic growth factors to help manage patients on therapy. The document should be read in conjunction with the previous document to identify changes. Some recommendations made in the previous document remain and are not discussed here.

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“…They respond to therapy in the same manner as do those with elevated ALT (13). Older patients can be treated successfully (14).…”

Section: Contraindicationsmentioning

confidence: 96%

Management of Chronic Hepatitis C: Consensus Guidelines

Sherman

Shafran

Burak

et al. 2007

Canadian Journal of Gastroenterology

102

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“…Dose reduction or treatment discontinuation may lower the SVR and result in 10-20% reduction in the patients' adherence to the treatment regimen (14). The higher rate of cytopenia in adults, mainly in the elderly, can be explained by their lower level of baseline hemoglobin and neutrophil and platelet counts (15). Some authors have suggested that severe cytopenia is a marker for increased tumor-necrosis-factor (TnF) activity in patients, and this increased TnF activity translates into higher SVR (16).…”

Section: Discussionmentioning

confidence: 99%

Hematological Adverse events and Sustained Viral Response in Children Undergoing Therapy for Chronic Hepatitis C Infection

Pawłowska¹,

Pilarczyk

Foksinska

et al. 2011

Hepat Mon

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Article type: original ArticleBackground: Treatment of hepatitis C virus (HCV) infection with interferon (IFn) and ribavirin (RBV) is associated with adverse events, which may affect the patient's adherence to the treatment regimen and the treatment efficacy. Objectives: The aim of this study was to assess the sustained viral response (SVR) and interdependence between the haematological characteristics (leukocyte count, platelet count, and haemoglobin levels) in patients with chronic hepatitis C (CHC) infection during treatment with IFn and RBV. Patients and Methods:We conducted a retrospective cohort study of 170 children with CHC infection who completed treatment with IFn-α and RBV. The children were divided into 2 groups: the first group (group I, n = 119) underwent a 48-week course of treatment with recombinant IFn α-2b (Intron A) at a dosage of 3 MU 3 times a week subcutaneously and RBV at a dosage of 15 mg/kg per day orally, and the second group (group II, n = 51) was administered pegylated IFn (peg-IFn)-α-2b (pegIntron) at a dosage of 1.5 µg/kg per week subcutaneously and RBV at a dosage of 15 mg/kg per day orally for 48 weeks. The dose of IFn was not adjusted but that of ribavirin was in 2 children from group II. Hematological growth factors and erythropoietin were not used. SVR was defined as undetectable serum HCV RnA 24 weeks after the end of treatment (study week 72). Serum HCV RnA was determined by performing polymerase chain reaction, and the HCV genotypes and hematological parameters were evaluated. Serum HCV RnA levels were analysed by descriptive statistics. Means and standard deviations were calculated for values collected at the baseline, on the 12th and 48th weeks during treatment, and after 24 weeks of untreated follow-up (study week 72). Results: eighty-six (50%) of the 170 patients who underwent treatment achieved SVR: 62 (51%) out of 119 children from group I and 24 (47%) out of 51 from group II. The mean serum hemoglobin levels and leukocyte and platelet counts at week 12 were significantly lower than the baseline values in both responders and non-responders from both the groups (P < 0.05). In the responders in group I, the mean levels of serum hemoglobin after 24 weeks of treatment and at the end of therapy were significantly lower than the mean levels at baseline. In the group treated with peg-IFn-α-2b and RBV (group II), the mean serum hemoglobin levels at week 12 was lower in the responders than in the non-responders (P < 0.05). The decrease in the hemoglobin levels was associated with viral response. In both the responders and nonresponders from both the groups, leukocyte counts decreased during treatment, and after 12 weeks, they were more significantly lower than the baseline value. The decrease was more marked in children treated with peg-IFn-α-2b + RBV (P < 0.05). After 12 weeks of treatment, the platelet count was low in children from group II who had achieved SVR. Conclusions: A mild decrease in hemoglobin levels and leukocyte and platelet counts during treatment with IFn and ...

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“…However, interferon therapy poses many challenges in elderly patients and those with advanced liver disease because of limited efficacy, safety, and tolerability [11]. Adverse effects, such as hemolytic anemia, are exacerbated in older patients [17][18][19][20][21]. Elderly patients are more likely to have concomitant comorbidities particularly metabolic (P \ 0.001) [11] and cardiovascular (P \ 0.001) [11] disease, along with renal, pulmonary, and hematologic conditions that prevent the use of PegIFN and RBV [22].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C Infection in the Elderly

2015

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Hepatitis C virus (HCV) infection in the elderly population is a global medical burden and healthcare utilization concern. The majority of patients with hepatitis C in the USA are "baby boomers," who were born between 1945 and 1965. Consistently worldwide, HCV infection in elderly population is overrepresented and poses public health concerns. These individuals have been infected now for over two decades and are presenting with advanced liver disease. Traditionally, the use of pegylated interferon-based therapy has been limited in the elderly because of its adverse effects. The sustained virologic responses have also tended to be lower in the elderly than in younger adults. The emergence of non-interferon-based therapy with direct acting antiviral agents has expanded the pool of patients eligible for treatment. These agents have been found to be effective, tolerable, and safe in the elderly population.

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Elderly Patients Are at Greater Risk of Cytopenia During Antiviral Therapy for Hepatitis C

Cited by 52 publications

References 15 publications

Management of Chronic Hepatitis C: Consensus Guidelines

Management of Chronic Hepatitis C: Consensus Guidelines

Hematological Adverse events and Sustained Viral Response in Children Undergoing Therapy for Chronic Hepatitis C Infection

Hepatitis C Infection in the Elderly

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