Original Article
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World J Gastroenterol. Sep 21, 2010; 16(35): 4400-4409
Published online Sep 21, 2010. doi: 10.3748/wjg.v16.i35.4400
Pegylated interferon α-2b plus ribavirin for older patients with chronic hepatitis C
Mosaburo Kainuma, Norihiro Furusyo, Eiji Kajiwara, Kazuhiro Takahashi, Hideyuki Nomura, Yuichi Tanabe, Takeaki Satoh, Toshihiro Maruyama, Makoto Nakamuta, Kazuhiro Kotoh, Koichi Azuma, Junya Shimono, Shinji Shimoda, Jun Hayashi, The Kyushu University Liver Disease Study Group
Mosaburo Kainuma, Norihiro Furusyo, Jun Hayashi, Department of General Internal Medicine, Kyushu University Hospital, Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
Eiji Kajiwara, Department of Internal Medicine, Nippon Steel Yawata Memorial Hospital, Harunomachi, Yahatahigashi-ku, Kitakyushu 805-0050, Japan
Kazuhiro Takahashi, Department of Medicine, Hamanomachi Hospital, Maiduru Chuo-ku, Fukuoka 810-8539, Japan
Hideyuki Nomura, The Center for Liver Disease, Shin-Kokura Hospital, Kanada, Kokurakita-ku, Kitakyushu, Fukuoka 803-8505, Japan
Yuichi Tanabe, Department of Medicine, Fukuoka City Hospital, Yoshiduka-honmachi, Hakata-ku, Fukuoka 812-0046, Japan
Takeaki Satoh, Center for Liver Disease, National Hospital Organization Kokura Medical Center, Harugaoka, Kokuraminami-ku, Kitakyushu 802-0803, Japan
Toshihiro Maruyama, Department of Medicine, Kitakyushu Municipal Medical Center, Bashaku, Kokurakita-ku Kitakyushu 802-0077, Japan
Makoto Nakamuta, Department of Gastroenterology, Kyushu Medical Center, National Hospital Organization, Jigyohama, Chuou-ku, Fukuoka 810-8563, Japan
Kazuhiro Kotoh, Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
Koichi Azuma, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
Junya Shimono, Saiseikai Yahata General Hospital, Haruno-machi, Yahatahigashi-ku, Kitakyushu, Fukuoka 805-0050, Japan
Shinji Shimoda, Department of Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, Higashi-Ku, Fukuoka 812-8582, Japan
The Kyushu University Liver Disease Study Group, Kyushu University, Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
Author contributions: Kajiwara E, Takahashi K, Nomura H, Tanabe Y, Satoh T, Maruyama T, Nakamuta M, Kotoh K, Azuma K, Shimono J, Shimoda S and The Kyushu University Liver Disease Study Group carried out the field research for the study; Kainuma M analyzed the data and wrote the paper; Furusyo N and Hayashi J were instrumental in developing and coordinating the research project and reviewed the manuscript.
Correspondence to: Jun Hayashi, MD, PhD, Professor, Department of General Internal Medicine, Kyushu University Hospital, Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan. hayashij@gim.med.kyushu-u.ac.jp
Telephone: +81-92-6425909 Fax: +81-92-6425916
Received: February 18, 2010
Revised: April 19, 2010
Accepted: April 26, 2010
Published online: September 21, 2010
Abstract

AIM: To analyze the efficacy and safety of a combination therapy of pegylated interferon (PEG-IFN) α-2b plus ribavirin (RBV) in older Japanese patients (65 years or older) infected with hepatitis C virus (HCV).

METHODS: This multicenter study included 938 patients with HCV genotype 1 who received 1.5 μg/kg per week PEG-IFN α-2b plus RBV 600-1000 mg/d for 48 wk and 313 HCV genotype 2 patients who received this treatment for 24 wk.

RESULTS: At 24 wk after the end of combination therapy, the overall sustained virological response (SVR) for genotypes 1 and 2 were 40.7% and 79.6%, respectively. The SVR rate decreased significantly with age in each genotype, and was markedly reduced in genotype 1 (P < 0.001). Moreover, the SVR was significantly higher in patients with genotype 1 who were less than 65 years (47.3% of 685) than in those 65 years or older (22.9% of 253) (P < 0.001) and was higher in patients with genotype 2 who were less than 65 years (82.9% of 252) than in those 65 years or older (65.6% of 61) (P = 0.004). When patients received a dosage at least 80% or more of the target dosage of PEG-IFN α-2b and 60% or more of the target dosage of RBV, the SVR rate significantly increased to 66.5% in patients less than 65 years and to 45.2% in those 65 years or older (P < 0.001). Adverse effects resulted in treatment discontinuation more often in patients with genotype 1 (14.4%) than in patients with genotype 2 (7.3%), especially by patients 65 years or older (24.1%).

CONCLUSION: PEG-IFN α-2b plus RBV treatment was effective in chronic hepatitis C patients 65 years or older who completed treatment with at least the minimum acceptable treatment dosage.

Keywords: Hepatitis C virus; Gerontology; Pegylated interferon; Ribavirin