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World J Gastroenterol. 2014 Aug 21;20(31):10984-93. doi: 10.3748/wjg.v20.i31.10984.

Age-related differences in response to peginterferon alfa-2a/ribavirin in patients with chronic hepatitis C infection.

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1
Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.

Abstract

AIM:

To evaluate the safety and efficacy of pegylated interferon alfa-2a and ribavirin therapy in elderly patients with chronic hepatitis C infection.

METHODS:

Patients characteristics, treatment results and safety profiles of 4859 patients with hepatitis c virus (HCV) infection receiving treatment with pegylated interferon alfa-2a and ribavirin were retrieved from a large ongoing German multicentre non-interventional study. Recommended treatment duration was 24 wk for GT 2 and GT 3 infection and 48 wk for GT 1 and GT 4 infection. Patients were stratified according to age (< 60 years vs ≥ 60 years). Because of limited numbers of liver biopsies for further assessment of liver fibrosis APRI (aspartate aminotransferase - platelet ratio index) was performed using pre-treatment laboratory data.

RESULTS:

Out of 4859 treated HCV patients 301 (6.2%) were ≥ 60 years. There were more women (55.8% vs 34.2%, P < 0.001) and predominantly GT 1 (81.4% vs 57.3%, P < 0.001) infected patients in the group of patients aged ≥ 60 years and they presented more frequently with metabolic (17.6% vs 4.5%, P < 0.001) and cardiovascular comorbidities (32.6% vs 6.7%, P < 0.001) and significant fibrosis and cirrhosis (F3/4 31.1% vs 14.0%, P = 0.0003). Frequency of dose reduction and treatment discontinuation were significantly higher in elderly patients (30.9% vs 13.7%, P < 0.001 and 47.8% vs 30.8%, P < 0.001). Main reason for treatment discontinuation was "virological non-response" (26.6% vs 13.6%). Sustained virological response (SVR) rates showed an age related difference in patients with genotype 1 (23.7% vs 43.7%, P < 0.001) but not in genotype 2/3 infections (57.7% vs 64.6%, P = 0.341). By multivariate analysis, age and stage of liver disease were independent factors of SVR.

CONCLUSION:

Elderly HCV patients differ in clinical characteristics and treatment outcome from younger patients and demand special attention from their practitioner.

KEYWORDS:

Epidemiology; Geriatric; Hepatitis C virus infection; Non-interventional study; Older patients; Patients ≥ 60 years; Therapy

PMID:
25152602
PMCID:
PMC4138479
DOI:
10.3748/wjg.v20.i31.10984
[Indexed for MEDLINE]
Free PMC Article

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