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

作者：Roeder Claudia; Jordan Sabine; zur Wiesch Julian Schulze; Pfeiffer Vornkahl Heike; Hueppe Dietrich; Mauss Stefan; Zehnter Elmar; Stoll Sabine; Alshuth Ulrich; Lohse Ansgar W; Lueth Stefan^*

来源：World Journal of Gastroenterology, 2014, 20(31): 10984-10993.

DOI：10.3748/wjg.v20.i31.10984

• Hepatitis C virus infection
• Older patients
• Patients > = 60 years
• Geriatric
• Therapy
• Non-interventional study
• Epidemiology

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.

• 出版日期2014-8-21