title: Elderly age is not a negative predictive factor for virological response to therapy with pegylated interferon-α and ribavirin in chronic hepatitis C virus patients.
abstract: OBJECTIVE
  Age is frequently discussed as negative host factor to achieve a sustained virological response (SVR) to antiviral therapy of chronic hepatitis C. However, elderly patients often show advanced fibrosis/cirrhosis as known negative predictive factor. The aim of this study was to assess age as an independent predictive factor during antiviral therapy.
  
  
  METHODS
  Overall, 516 hepatitis C patients were treated with pegylated interferon-α and ribavirin, thereof 66 patients ≥60 years. We analysed the impact of host factors (age, gender, fibrosis, haemoglobin, previous hepatitis C treatment) and viral factors (genotype, viral load) on SVR per therapy course by performing a generalized estimating equations (GEE) regression modelling, a matched pair analysis and a classification tree analysis.
  
  
  RESULTS
  Overall, SVR per therapy course was 42.9 and 26.1%, respectively, in young and elderly patients with hepatitis C virus (HCV) genotypes 1/4/6. The corresponding figures for HCV genotypes 2/3 were 74.4 and 84%. In the GEE model, age had no significant influence on achieving SVR. In matched pair analysis, SVR was not different in young and elderly patients (54.2 and 55.9% respectively; P = 0.795 in binominal test). In classification tree analysis, age was not a relevant splitting variable.
  
  
  CONCLUSIONS
  Age is not a significant predictive factor for achieving SVR, when relevant confounders are taken into account. As life expectancy in Western Europe at age 60 is more than 20 years, it is reasonable to treat chronic hepatitis C in selected elderly patients with relevant fibrosis or cirrhosis but without major concomitant diseases, as SVR improves survival and reduces carcinogenesis.
authors.affiliation: Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Pascal
authors.initials: P
authors.lastname: Frei
authors.forename: Anna-Kathrin
authors.initials: AK
authors.lastname: Leucht
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
authors.forename: Reto
authors.initials: R
authors.lastname: Kofmehl
authors.forename: Christine N
authors.initials: CN
authors.lastname: Manser
authors.forename: Johannes
authors.initials: J
authors.lastname: Schmitt
authors.forename: Joachim
authors.initials: J
authors.lastname: Mertens
authors.forename: Monika
authors.initials: M
authors.lastname: Rau
authors.forename: Katharina
authors.initials: K
authors.lastname: Baur
authors.forename: Tilman
authors.initials: T
authors.lastname: Gerlach
authors.forename: Francesco
authors.initials: F
authors.lastname: Negro
authors.forename: Markus
authors.initials: M
authors.lastname: Heim
authors.forename: Darius
authors.initials: D
authors.lastname: Moradpour
authors.forename: Andreas
authors.initials: A
authors.lastname: Cerny
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
authors.forename: Beat
authors.initials: B
authors.lastname: Müllhaupt
authors.forename: Andreas
authors.initials: A
authors.lastname: Geier
mesh_terms: D000367:Age Factors; D000368:Aged; D005838:Genotype; D006454:Hemoglobins / Q000378:metabolism; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D016898:Interferon-alpha / Q000494:pharmacology / Q000627:therapeutic use*; D016555:Matched-Pair Analysis; D011092:Polyethylene Glycols / Q000494:pharmacology / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012044:Regression Analysis; D012254:Ribavirin / Q000494:pharmacology / Q000627:therapeutic use*; D012737:Sex Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D006454:Hemoglobins; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: age; elderly; hepatitis C therapy; host factor; matched pair analysis; pegylated interferon-alfa; ribavirin