The Effect of Age on Response to Therapy With Peginterferon ? Plus Ribavirin in a Cohort of Patients With Chronic HCV Hepatitis Including Subjects Older Than 65 Yr

Abstract

The probability of good response to combination treatment with peginterferon alpha plus ribavirin is decreased for patients aged more than 40 years infected with genotype 1 or 4, but patients aged more than 65 had a similar rate of response to those aged 40-64 years. Combination treatment may be safely extended to elderly patients with no major contraindications.

Rate and Factors Affecting Treatment Uptake of Patients with Chronic Hepatitis C in a Tertiary Referral Hospital

“…However, this group of patients is at greatest risk of aggressive disease progression and is most in need of antiviral therapy. Recent studies showed that, different from conventional interferon and ribavirin therapy, patients over the age of 65 could achieve similar sustained virological response to younger patients when treated with peginterferon and ribavirin combination therapy if they were able to adhere to the treatment [25,26]. They were, however, more likely to suffer from adverse events, to require dose modification or to discontinue treatment [25,26].…”

“…Recent studies showed that, different from conventional interferon and ribavirin therapy, patients over the age of 65 could achieve similar sustained virological response to younger patients when treated with peginterferon and ribavirin combination therapy if they were able to adhere to the treatment [25,26]. They were, however, more likely to suffer from adverse events, to require dose modification or to discontinue treatment [25,26]. It has also been shown that eradication of virus in elderly patients can still lead to improved morbidity and mortality in the long term [27,28].…”

Hepatitis C Infection in the Elderly

“…However, the age threshold of 60 years is used by the by World Health Organization (WHO) to define individuals as elderly and by National Health and Nutrition Examination Survey (NHANES) to stratify individuals as those having advanced age [7,8]. In studies, both age thresholds of 60 and 65 years are used to define the elderly [9][10][11][12]. The chronic nature of hepatitis C virus (HCV) infection and the increasing life expectancy in industrialized societies make it likely that physicians will face a growing number of advanced age patients with HCV infection in the next decade [13,14].…”

Predictive Factors for Response to Peginterferon-Alpha and Ribavirin Treatment of Chronic HCV Infection in Patients Aged 65 Years and More

“…These figures, however, have been obtained in patients aged between 40 and 50 years, as patients with more advanced age have been excluded from large therapeutic trials [8,9]. Some retrospective studies on this subject reported variable SVR results, while a recent prospective controlled study has shown that PEG-IFN and ribavirin treatment in patients aged C65 years is less tolerated than in younger patients, and poor compliance due to side effects may be responsible for the low SVR rates observed in this patient population [10][11][12][13]. Nevertheless, pre-treatment predictors of SVR have not been clearly characterized in elderly patients with HCV undergoing antiviral therapy, and it is not known whether early ''stopping rules'' for treatment can also be effectively applied to this particular patient population [14].…”