Hepatitis
C Patients over Age 50 Are Less Likely to Achieve
Sustained Treatment Response
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| SUMMARY:
Individuals with genotype
1 chronic hepatitis C virus (HCV) infection
who are older than 50 years have a lower
rate of sustained
response to pegylated
interferon plus ribavirin compared with
younger patients, according to a study published
in the October 2009 Journal of Viral
Hepatitis. Response rates were high,
however, among older patients without liver
cirrhosis who maintained adequate drug levels
and those who achieved rapid or complete
early virological response. |
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By
Liz Highleyman
How
well older individuals respond to hepatitis
C treatment is an important issue, as the average
age of patients starting therapy is increasing. Several
past studies indicated that older patients do not
respond as younger ones to interferon-based therapy,
but the factors influencing age-related differences
in response are not well understood.
In
the present study, K.R. Reddy and colleagues evaluated
data from 569 patients with genotype 1 chronic HCV
infection enrolled in 2 randomized Phase 3 clinical
trials (NV15801 and NV15942) looking at 180 mcg/week
pegylated
interferon alfa-2a (Pegasys) plus 1000-1200 mg/day
weight-adjusted ribavirin for 48 weeks.
Results
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Overall,
patients age 50 or younger were significantly
more likely to achieve sustained virological response
(SVR) -- or undetectable HCV RNA 24 weeks after
completion of therapy -- than patients over 50
(52% vs 39%, respectively; P = 0.0073). |
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SVR
rates were higher, however, among older patients
who demonstrated good response at early stages
of treatment: |
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83%
for those who achieved rapid virological
response (RVR), or undetectable HCV RNA
at week 4; |
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61%
for those with complete early virological
response (cEVR), or detectable HCV RNA at
week 4 but < 50 IU/mL at week 12. |
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Patients
over 50 had a significantly higher relapse rate
than younger individuals (41% vs 25%, respectively;
P = 0.0042). |
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Older
patients had significantly lower cumulative blood
concentrations of both pegylated interferon and
ribavirin compared with younger participants (252
vs 304 g, respectively, for ribavirin; P <
0.0001). |
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In
a multivariate analysis, cumulative drug exposure
and achievement of RVR or complete EVR were significant
predictors of SVR in patients over 50. |
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Other
baseline characteristics that predicted SVR in
older patients were lower baseline HCV viral load
(P = 0.0067), higher ALT ratio (P = 0.0113), and
absence of cirrhosis (P = 0.0482). |
"Response
rates were high among patients > 50 years without
cirrhosis who maintained adequate drug exposure and
those achieving an RVR or cEVR," the study authors
concluded.
They
suggested that more frequent ribavirin dose modification
among older patients likely contributed to the observed
higher relapse rate.
Hospital
of the University of Pennsylvania, Philadelphia, PA;
IST GmbH, Mannheim, Germany; Roche, Basel, Switzerland;
Henry Dunant Hospital, Athens, Greece.
12/1/09
Reference
KR
Reddy, D Messinger, M Popescu, and others. Peginterferon
alfa-2a (40kDa) and ribavirin: comparable rates of
sustained virological response in sub-sets of older
and younger HCV genotype 1 patients. Journal of
Viral Hepatitis 16(10): 724-731. October 2009.
(Abstract).
