Interferon therapy for aged patients with chronic hepatitis C: improved survival in patients exhibiting a biochemical response

Imai, Yumiko; Kasahara, Akinori; Tanaka, Hideo; Okanoue, Takeshi; Hiramatsu, Naoki; Tsubouchi, Hirohito; Yoshioka, Kentaro; Kawata, Satoshi; Tanaka, Eiji; Hino, Keisuke; Hayashi, Katsuhiro; Tamura, Shinji; Itoh, Yoshito; Sasaki, Yutaka; Kiyosawa, Kendo; Kakumu, Shinichi; Okita, Kiwamu; Hayashi, Norio

doi:10.1007/s00535-004-1448-0

Cited by 44 publications

(34 citation statements)

References 34 publications

(40 reference statements)

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“…level might benefi t from IFN therapy, although they should decide the indications for IFN very carefully in this age group. Imai et al [8] reported that some aged patients with chronic hepatitis C might be recommended IFN therapy.…”

Section: Discussionmentioning

confidence: 99%

“…When such aged chronic hepatitis C patients with abnormal ALT levels consult a doctor, the fi rst problem is whether or not therapy should be used for chronic hepatitis C. Moreover, when treatment for chronic hepatitis C is decided in such aged patients, whether IFN therapy should be used or not is the second problem. However, a few studies have targeted IFN therapy and prolonged prognosis in elderly patients with chronic hepatitis C [7,8] . Until now, IFN treatment for chronic hepatitis C has mainly been introduced when patients are less than 60-65 years of age because of IFN-related side effects and safety standards in Japan.…”

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confidence: 99%

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Long-Term Outcome after Interferon Therapy in Elderly Patients with Chronic Hepatitis C

et al. 2006

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Objective: The purpose of this study was to elucidate the long-term outcome after interferon (IFN) therapy in chronic hepatitis C elderly patients. Methods: We studied the incidence of hepatocellular carcinoma (HCC) and survival probability after the initiation of IFN therapy in 500 Japanese chronic hepatitis C patients >60 years. The mean age of initiation of IFN was 63 years and the mean follow-up period was 7.4 years. Cox proportional hazard regression analysis was used to evaluate the long-term outcome after initiation of IFN therapy.Sustained virological response (SVR) was defined as negative HCV-RNA by RT-nested PCR 6 months after the completion of long-term IFN therapy. Non-response (NR) was applied to patients who did not show SVR. Hepatic fibrosis was defined as the fibrosis score (score 0–4) according to Knodell et al. Results: 140 patients (28%) had an SVR and 360 patients (72%) had an NR. 71 of 500 patients developed HCC during follow-up. The cumulative incidence of HCC was 9.6% at the 5th year, 17.4% at the 10th year, and 31.3% at the 15th year. HCC developed with significance when: (1) HCV was not cleared after IFN therapy (p < 0.0001), (2) sex was male (p < 0.0001), and (3) staging of liver fibrosis was >2 (p = 0.008). 53 of the patients died. The cumulative survival probability was 95.7% at the 5th year, 86.4% at the 10th year, and 78% at the 15th year. Patients achieved a long survival with significance when: (1) staging of liver fibrosis was 1 (p < 0.0001), (2) HCV was cleared after IFN therapy (p = 0.034), and (3) sex was female (p = 0.015). Conclusion: Chronic hepatitis C patients with clearance of HCV after IFN therapy had a significantly reduced risk of HCC appearance and achieved prolonged survival even if they are ≧60 years.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Long-Term Outcome after Interferon Therapy in Elderly Patients with Chronic Hepatitis C

et al. 2006

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“…Although IFN therapy for chronic hepatitis C, both with standard and pegylated drugs, is commonly thought to prevent or delay HCC 5, [7][8][9]13 , in the present case severity of disease unexpectedly increased during treatment and concomitantly with viral clearance. On the grounds of its local diffuseness, the tumor was seemingly pre-existing, however neither laboratory tests nor ultrasound investigation had diagnosed it previously, and despite unhomogeneous liver echotexture with hypo-and hyperechoic scattered areas, nevertheless focal lesions were not identifiable.…”

Section: Discussionmentioning

confidence: 65%

“…Specifically, HCV-related liver cirrhosis accounts for about 4% risk per year of developing HCC [5][6] , and the tumor incidence in North America, Europe and Japan is increasing, mainly as a consequence of HCV diffusion during the previous decades 1 . Although the mechanisms by which the virus promotes hepatocarcinogenesis are not completely clear yet, interferon (IFN) therapy seems of benefit in preventing HCC, owing to antimitogenic and antioxidative properties, both in sustained virological responders and in transient biochemical responders [7][8][9] . Since tumor diffusion significantly limits an effective removal of lesions 4 , procedures for disclosing primary nodules in cirrhotics have been carefully standardized by major scientific societies 10 .…”

Section: Introductionmentioning

confidence: 99%

Occurrence of Diffuse, Poorly Differentiated Hepatocellular Carcinoma During Pegylated Interferon Plus Ribavirin Combination Therapy for Chronic Hepatitis C

Capanni

Lorefice²,

Benini³

et al. 2008

Journal of Chemotherapy

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SummaryInterferon therapy is indicated for the treatment of chronic hepatitis C and prevention of hepatocellular carcinoma. We describe the case of a 66-year-old Italian woman who received pegylated interferon α α-2a plus ribavirin combined therapy for HCV-related chronic liver disease. Preliminary hematochemical, ultrasound and bioptic investigations did not show liver cirrhosis or hepatocarcinoma. After 24 weeks of treatment transaminase serum levels were in the normal range and circulating HCV-RNA was undetectable by PCR qualitative assay. On week 46 a serious adverse event occurred, with rapid transaminase increase, severe hyperpyrexia, and abdominal pain, leading to interruption of interferon and ribavirin. Liver biopsy was repeated and it revealed poorly differentiated hepatocellular carcinoma. Only palliative care could be performed and the patient died of liver failure within 2 months. The present case underlines that hepatocellular carcinoma can be misdiagnosed in spite of laboratory and instrumental follow-up. More sensitive tools are needed for tumor detection, to avoid IFN impairment of the liver, even though it eradicates HCV.

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“…Imai et al 16 reported that IFN therapy reduced liver-related mortality in aged patients with chronic hepatitis C, especially in those exhibiting a biochemical response as well as a sustained virological response. If this result is correct, some aged patients with chronic hepatitis C might be recommended for IFN therapy.…”

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confidence: 98%

Efficacy of interferon therapy for aged patients with chronic hepatitis C

Arase

Kumada

2004

J Gastroenterol

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Interferon therapy for aged patients with chronic hepatitis C: improved survival in patients exhibiting a biochemical response

Abstract: These results suggest that IFN treatment could reduce liver-related mortality in chronic hepatitis C patients over age 60, notably in patients showing a biochemical response and in those showing a sustained virological response.

Cited by 44 publications

References 34 publications

Long-Term Outcome after Interferon Therapy in Elderly Patients with Chronic Hepatitis C

Long-Term Outcome after Interferon Therapy in Elderly Patients with Chronic Hepatitis C

Occurrence of Diffuse, Poorly Differentiated Hepatocellular Carcinoma During Pegylated Interferon Plus Ribavirin Combination Therapy for Chronic Hepatitis C

Efficacy of interferon therapy for aged patients with chronic hepatitis C

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