Disadvantages of peginterferon and ribavirin treatment in older patients with chronic hepatitis C: an analysis using the propensity score.
OBJECTIVE
Peginterferon (PEG-IFN) and ribavirin (RBV) combination treatment for patients with chronic hepatitis C (CHC), infected by genotype-1 hepatitis C virus with high viral loads, results in a sustained viral response (SVR) in ~50%. However, a trend of decreasing SVR in the older patients has been reported. In the present study, we verified this trend of treatment efficacy in older patients using the propensity score (PS).


METHODS
We conducted a survey of 327 patients with CHC (genotype 1 and high viral loads) who were treated with PEG-IFN and RBV for 48 weeks. The SVR rate was compared between patients =60 and <60 years of age. Because backgrounds of these patients differed considerably, we verified this efficacy between the older (n = 102) and younger (n = 102) patients matched for gender, body weight, platelets (PLT), and red blood cell (RBC) counts using PS.


RESULTS
The total SVR rate was 42.9% (161/327); this rate decreased with increasing age and was lower in the older patients (≥60 years: 41.5%, <60 years: 54.3%, P = 0.0245). Moreover, younger age was a significant factor for SVR. After correction by PS, the SVR in older patients remained significantly lower (≥60 years: 43.1%, <60 years: 57.8%, P = 0.0497). In addition, RBC counts and hemoglobin (Hgb) concentrations, as well as RBV adherence in the older patients, decreased with this treatment, although there were no significant differences in pretreatment RBC and Hgb levels.


CONCLUSIONS
The analysis using PS indicated that RBV adherence in the older patients decreased even if they did not have lower pretreatment RBC and Hgb levels.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Hirotoshi
H
Ebinuma
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. hsaito@sc.itc.keio.ac.jp.|Department of Pharmacotherapeutics, Faculty of Pharmacy, Keio University, 1-5-30 Shiba-Kohen, Minato-ku, Tokyo, 105-8512, Japan. hsaito@sc.itc.keio.ac.jp.
Hidetsugu
H
Saito
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Shinichiro
S
Tada
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Nobuhiro
N
Nakamoto
The Center for Liver Diseases, Department of Internal Medicine, Kitasato Institute Hospital, Tokyo, Japan.
Tazuko
T
Ohishi
The Center for Liver Diseases, Department of Internal Medicine, Kitasato Institute Hospital, Tokyo, Japan.
Satoshi
S
Tsunematsu
The Center for Liver Diseases, Department of Internal Medicine, Kitasato Institute Hospital, Tokyo, Japan.
Naoki
N
Kumagai
The Center for Liver Diseases, Department of Internal Medicine, Kitasato Institute Hospital, Tokyo, Japan.
Kanji
K
Tsuchimoto
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saiseikai Central Hospital, Tokyo, Japan.
Nobuhiro
N
Tsukada
Department of Internal Medicine, Nihon Kohkan Hospital, Kawasaki, Japan.
Yasutaka
Y
Inagaki
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Eiju General Hospital, Tokyo, Japan.
Yoshinori
Y
Horie
Department of Gastroenterology and Hepatology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Masahiko
M
Takahashi
Department of Gastroenterology and Hepatology, Hiratsuka City Hospital, Hiratsuka, Japan.
Kazuhiro
K
Atsukawa
Department of Internal Medicine, Sanokousei Hospital, Sano, Japan.
Yukishige
Y
Okamura
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Takanori
T
Kanai
Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Toshifumi
T
Hibi