Treatment Response and Tolerability of Pegylated Interferon-α Plus Ribavirin Combination Therapy in elderly Patients (≥ 65 years) With Chronic Hepatitis C in Korea

Abstract

BackgroundThe prevalence of hepatitis C virus (HCV) infections in elderly patients has been increasing in a number of countries. A few reports concerning pegylated interferon-α (PEG-IFN-α)-based combination treatment in elderly chronic hepatitis C (CHC) patients have been published, with slightly different treatment outcomes.ObjectivesWe investigated the treatment response and safety of PEG-IFN-α plus ribavirin combination therapy in elderly patients with CHC.Patients and MethodsAmong a total of 181 treatment-naïve CHC patients (60 patients with genotype 1, 121 patients with genotype 2 or 3), 38 were aged ≥ 65 years (defined as the elderly group) and 143 were aged < 65 years (defined as the non-elderly group).ResultsThe overall sustained virologic response (SVR) was lower in the elderly group than in the non-elderly group, but it was not significantly different (65.8 % vs. 76.2 %, P = 0.15). In a subgroup analysis, among patients with genotype 1, the elderly group had a significantly lower SVR rate than the non-elderly group (30.8 % vs. 66.0 %, P = 0.03). However, the SVR rate in patients with HCV genotype 2 or 3 was comparable between the two groups (84.0 % vs. 81.3 %, P = 0.85). HCV genotype was significantly associated with SVR in the elderly patients (genotype 1 vs. 2 or 3, odds ratio: 0.18, 95% confidence interval: 0.000-0.869, P = 0.03). The incidence of premature discontinuation of treatment (21.1 % vs. 9.1 %, P = 0.05) and dose modification (52.6 % vs. 31.5 %; P = 0.02) due mainly to adverse events or laboratory abnormalities, were higher in the elderly group than in the non-elderly group.ConclusionsPEG-IFN-α plus ribavirin combination therapy might be considered for elderly CHC patients, especially for genotype 2 or 3, with vigilant monitoring of adverse events.

Determinant Factors of the Direct Medical Costs Associated with Genotype 1 Hepatitis C Infection in Treatment-Experienced Patients

“…Older patients are exposed to many debilitating conditions such as arthritis, depression, fatigue and anaemia; conditions with symptoms that also accompany CHC. Hence, detecting CHC might be challenging in older patients, given the underestimation of its true prevalence among aged patients, who are more likely to develop advanced liver disease [ 32 , 33 ]. Observations from other studies reported that anaemic patients were more likely to be older, to be female and to have lower BMI [ 34 – 36 ].…”

KASL clinical practice guidelines: Management of Hepatitis C

“…The elderly (>65 years of age) often have advanced liver diseases with higher necessity of treatment, 223 but the SVR rates are lower and the adverse effects are more frequent. 224 , 225 However, treatment of elderly hepatitis C patients can decrease the incidence rate of HCC and increase the survival rate. 226 , 227 A recent study reported that the SVR rate in patients >60 years of age is similar to that of patients in 50-59 years of age.…”

Changing of HCV Clade Pattern in Iran; the Possible Means for Something Good

“…The standard therapy of interferon plus ribavirin against HCV infection exhibits various efficacies on different viral genotypes. Forty six percent of patients infected with genotype 1 achieved sustained virologic response (SVR), while the SVR shown by patients infected with genotype 3 was more than 80 % ( 8 ). The changing pattern of HCV clades in Iran showed that HCV 3a might be more prevalent genotype in future.…”