Observational Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2014; 20(31): 10984-10993
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10984
Age-related differences in response to peginterferon alfa-2a/ribavirin in patients with chronic hepatitis C infection
Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Heike Pfeiffer-Vornkahl, Dietrich Hueppe, Stefan Mauss, Elmar Zehnter, Sabine Stoll, Ulrich Alshuth, Ansgar W Lohse, Stefan Lueth
Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany
Heike Pfeiffer-Vornkahl, Factum - company for statistics, scientific information and communication mbH, 63065 Offenbach, Germany
Dietrich Hueppe, Center of Gastroenterology, Wiescherstrasse 20, 44623 Herne, Germany
Stefan Mauss, Center for HIV and Hepatogastroenterology, Grafenberger Allee 128a, 40237 Duesseldorf, Germany
Elmar Zehnter, Center of Gastroenterology, Am Oelpfad 12, 44263 Dortmund, Germany
Sabine Stoll, Ulrich Alshuth, Virology, Roche Pharma AG, Emil-Barell-Straße 1, 79639 Grenzach-Wyhlen, Germany
Author contributions: Jordan S and Roeder C lead this research and contributed equally to this work; all authors contributed to the study design, collected clinical data, evaluated the data, critically assessed the manuscript and gave final approval for submission.
Supported by Grants of the Deutsche Forschungsgemeinschaft (to zur Wiesch JS), No. DFG Grant LU B62/2-1 and No. SFB841 A6; and The Deutsches Zentrum für Infektionsforschung (to zur Wiesch JS)
Correspondence to: Dr. Stefan Lueth, PD, Department of Medicine I, University Hospital Hamburg Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. slueth@uke.de
Telephone: +49-40-741051859 Fax: +49-40-741040272
Received: January 13, 2014
Revised: February 20, 2014
Accepted: May 28, 2014
Published online: August 21, 2014
Processing time: 218 Days and 23.5 Hours
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: Hepatitis C virus infection; Older patients; Patients ≥ 60 years; Geriatric; Therapy; Non-interventional study; Epidemiology

Core tip: There are concerns to initiate treatment in elderly patients because of perceived lower sustained virological response (SVR) rates and serious adverse events. We aimed to evaluate safety and efficacy of pegylated interferon alfa-2a and ribavirin therapy in elderly patients. Patients were stratified according to age (< 60 years vs≥ 60 years). 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). Elderly hepatitis C virus patients differ in clinical characteristics and treatment outcome from younger patients and demand special attention from their practitioner.