Treatment Response and Tolerability of Pegylated Interferon-? Plus Ribavirin Combination Therapy in elderly Patients (? 65 years) With Chronic Hepatitis C in Korea

Background: The prevalence of hepatitis C virus (HCV) infections in elderly patients has been increasing in a number of countries. A few reports concerning pegylated interferon-α (PEG-IFN-α)-based combination treatment in elderly chronic hepatitis C (CHC) patients have been published, with slightly different treatment outcomes.
Objectives: We investigated the treatment response and safety of PEG-IFN-α plus ribavirin combination therapy in elderly patients with CHC.
Patients and Methods: Among a total of 181 treatment-naïve CHC patients (60 patients with genotype 1, 121 patients with genotype 2 or 3), 38 were aged ≥ 65 years (defined as the elderly group) and 143 were aged < 65 years (defined as the non-elderly group).
Results: The overall sustained virologic response (SVR) was lower in the elderly group than in the non-elderly group, but it was not significantly different (65.8 % vs. 76.2 %, P = 0.15). In a subgroup analysis, among patients with genotype 1, the elderly group had a significantly lower SVR rate than the non-elderly group (30.8 % vs. 66.0 %, P = 0.03). However, the SVR rate in patients with HCV genotype 2 or 3 was comparable between the two groups (84.0 % vs. 81.3 %, P = 0.85). HCV genotype was significantly associated with SVR in the elderly patients (genotype 1 vs. 2 or 3, odds ratio: 0.18, 95% confidence interval: 0.000-0.869, P = 0.03). The incidence of premature discontinuation of treatment (21.1 % vs. 9.1 %, P = 0.05) and dose modification (52.6 % vs. 31.5 %; P = 0.02) due mainly to adverse events or laboratory abnormalities, were higher in the elderly group than in the non-elderly group.
Conclusions: PEG-IFN-α plus ribavirin combination therapy might be considered for elderly CHC patients, especially for genotype 2 or 3, with vigilant monitoring of adverse events.

Implication for health policy/practice/research/medical education:
The care of older patients with chronic hepatitis C (CHC) is one of the most important issues confronted by physicians. The results of this study suggest that PEG-IFN-α plus ribavirin combination therapy might be considered for elderly chronic hepatitis C patients, especially for genotype 2 or 3, with vigilant monitoring of adverse events.
Please cite this paper as:
Kim HI, Kim IH, Jeon BJ, Lee S, Kim SH, Kim SW, et al. Treatment Response and Tolerability of Pegylated Interferon-α Plus Ribavirin Combination Therapy in Elderly Patients (≥ 65 years) With Chronic Hepatitis C in Korea. Hepat Mon. 2012;12(7):430-6. DOI: 10.5812/hepatmon.6170

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