Reuters Health Information (2012-11-22): Standard hep C treatment less effective in elderly
Standard hep C treatment less effective in elderly
Last Updated: 2012-11-22 9:00:49 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Ribavirin plus pegylated interferon alfa is less effective against hepatitis C in elderly patients than in similar middle-aged individuals, new data show.
Despite this finding, and despite higher withdrawal rates among elderly patients in the study, most older patients should still receive the drugs, according to a November 5th paper in Alimentary Pharmacology and Therapeutics.
Dr. R. -N. Chien from Chang Gung Memorial Hospital and University, Keelung, Taiwan and colleagues compared the efficacy and safety of pegylated interferon plus ribavirin in 182 patients with chronic hepatitis C virus (HCV) infection, including 81 who were over 65 and another 81 between the ages of 50 and 64. Patients in the two groups were matched by gender and genotype.
All patients received weekly subcutaneous pegylated interferon injection plus daily oral ribavirin for 24 weeks.
Similar percentages of older and middle-aged patients had a rapid virological response (i.e., within four weeks): 56.2% and 65.1%, respectively.
Complete early virological response rates (that is, within 12 weeks) were also similar: 83.3% vs 90.6% for the older vs younger patients.
Although end-of-treatment response rates were also statistically similar (79% in elderly patients and 89% in the middle-aged cohort), the sustained virological response was significantly lower in the older group (40.7% vs 61.5%; p=0.005).
In both groups, the rate of sustained virological response was significantly higher and the relapse rate significantly lower when patients didn't have genotype-1.
In multivariate analysis, rapid virological response was the strongest predictor for sustained virological response, followed by HCV genotype non-1, male gender, younger age, and higher pretreatment platelet count.
The elderly patients had higher withdrawal rates because of intolerance to treatment-related adverse effects (13.2% vs 7.7%) and were more likely to need the interferon dose reduced because of side effects (14.3% vs 3%).
Otherwise, however, the patients in both groups had similar adverse effect profiles.
"In view of prolonged lifespan and moderate efficacy of combination therapy in geriatric patients," the researchers conclude, "treatment is recommended in geriatric HCV-infected patients with significant hepatic fibrosis and no other health problems."
Dr. Chien did not respond to a request for comments.
Aliment Pharmacol Ther 2012.