How Effective Is Pegylated Interferon plus Ribavirin for HCV Genotype 1 Patients Over Age 50?
The prognosis of patients with chronic hepatitis C is influenced by viral factors such as HCV genotype and HCV RNA level, as well as patient factors such as age, sex, race, presence of cirrhosis, and adherence to therapy.
The demographics of HCV infection have shifted in recent years, and an increasing number of chronic hepatitis C patients now in their 50’s.
To assess the impact of age on sustained virological response (SVR) rates, researchers analyzed the data from 2 large phase III studies of pegylated interferon alfa-2a (Pegasys) plus ribavirin (Fried et al. NEJM 2002 and Hadziyannis et al. Ann Intern Med 2004). Results were reported at the 58th Annual Meeting of the American Association for the Study of Liver Diseases in Boston (November 2-6, 2007).
The investigators included patients with HCV genotype 1 who were randomized to 48 weeks of treatment with 180 mcg/week Pegasys plus 1000-200 mg/day ribavirin. SVR was defined as undetectable HCV RNA by qualitative PCR 24 weeks after completion of treatment.
In conclusion, the study investigators wrote, "SVR rates in certain subgroups (those without advanced fibrosis, low HCV RNA levels) of older patients are comparable to younger patients, especially if high rates of adherence can be maintained."
They also noted that although ribavirin dose reductions were more common in chronic hepatitis C patients older than 50 years of age, "these patients can be effectively treated."
Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA; 2Ist GmbH, Mannheim, Germany; Roche, Basel, Switzerland; Henry Dunant Hospital, Athens, Greece.
This research was funded by Roche, Basel, Switzerland.
R Reddy, D Messinger, M Popescu, and others. High rates of sustained virologic response (SVR) in patients >50 years infected with HCV genotype 1 with positive prognostic factors treated with peginterferon alfa-2a (40KD) (Pegasys) and ribavirin (Copegus). 58th Annual Meeting of the American Association for the Study of Liver Diseases. Boston, MA, November 2-6, 2007. Abstract 321.