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Indications and limitations for aged patients with chronic hepatitis C in pegylated interferon alfa-2b plus ribavirin combination therapy

2010; Elsevier BV; Volume: 54; Issue: 4 Linguagem: Inglês

10.1016/j.jhep.2010.07.043

1600-0641

Tsugiko Oze, Naoki Hiramatsu, Takayuki Yakushijin, Kiyoshi Mochizuki, Masahide Oshita, Hideki Hagiwara, Eiji Mita, Toshifumi Ito, Hiroyuki Fukui, Yoshiaki Inui, Taizo Hijioka, Masami Inada, Kazuhiro Kaytayama, Shinji Tamura, Harumasa Yoshihara, Atsuo Inoue, Yasuharu Imai, Michio Kato, Takuya Miyagi, Yuichi Yoshida, Tomohide Tatsumi, Shinichi Kiso, Tatsuya Kanto, Akinori Kasahara, Tetsuo Takehara, Norio Hayashi,

Hepatitis B Virus Studies

Background & Aims This study investigated the efficacy and adverse effects of pegylated interferon (Peg-IFN) plus ribavirin therapy in aged patients with chronic hepatitis C (CH-C). Methods A total of 1040 naïve patients with CH-C (genotype 1, n = 759; genotype 2, n = 281), of whom 240 (23%) over 65 years old (y.o.), were treated with Peg-IFN alfa-2b plus ribavirin and assessed after being classified into five categories, according to age. Results The discontinuance rate was higher for patients over 70 y.o. (36%), the most common reason being anemia. In the presence of genotype 1, the SVR rate was similar (42–46%) among patients under 65 y.o. and declined (26–29%) among patients over 65 y.o. For patients over 65 y.o., being male (Odds ratio, OR, 3.5, p= 0.035) and EVR (OR, 83.3, p<0.001) were significant factors for SVR, in multivariate analysis. The Peg-IFN dose was related to EVR, and when EVR was attained, 76–86% of patients over 65 y.o. achieved SVR. SVR was not achieved (0/35, 0/38, respectively) if a 1-log decrease and a 2-log decrease were not attained at week 4 and week 8, respectively. In the presence of genotype 2, the SVR rate was similar (70–71%) among patients under 70 y.o. and declined among patients over 70 y.o. (43%). Conclusions Aged patients up to 65 y.o. with genotype 1 and 70 y.o. with genotype 2 can be candidates for Peg-IFN plus ribavirin therapy. The response-guided therapy can be applied for aged patients with genotype 1. This study investigated the efficacy and adverse effects of pegylated interferon (Peg-IFN) plus ribavirin therapy in aged patients with chronic hepatitis C (CH-C). A total of 1040 naïve patients with CH-C (genotype 1, n = 759; genotype 2, n = 281), of whom 240 (23%) over 65 years old (y.o.), were treated with Peg-IFN alfa-2b plus ribavirin and assessed after being classified into five categories, according to age. The discontinuance rate was higher for patients over 70 y.o. (36%), the most common reason being anemia. In the presence of genotype 1, the SVR rate was similar (42–46%) among patients under 65 y.o. and declined (26–29%) among patients over 65 y.o. For patients over 65 y.o., being male (Odds ratio, OR, 3.5, p= 0.035) and EVR (OR, 83.3, p<0.001) were significant factors for SVR, in multivariate analysis. The Peg-IFN dose was related to EVR, and when EVR was attained, 76–86% of patients over 65 y.o. achieved SVR. SVR was not achieved (0/35, 0/38, respectively) if a 1-log decrease and a 2-log decrease were not attained at week 4 and week 8, respectively. In the presence of genotype 2, the SVR rate was similar (70–71%) among patients under 70 y.o. and declined among patients over 70 y.o. (43%). Aged patients up to 65 y.o. with genotype 1 and 70 y.o. with genotype 2 can be candidates for Peg-IFN plus ribavirin therapy. The response-guided therapy can be applied for aged patients with genotype 1.