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 pro...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 pegylatedinterferon 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.展开更多
基金Supported by Grants of the Deutsche Forschungsgemeinschaft(to zur Wiesch JS),No.DFG Grant LU B62/2-1 and No.SFB841 A6the Deutsches Zentrum für Infektionsforschung(to zur Wiesch JS)
文摘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 pegylatedinterferon 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.
