title: Efficacy and safety of peginterferon plus ribavirin for patients aged ≥ 65 years with chronic hepatitis C: a systematic review and meta-analysis.
abstract: METHODS
  Studies up to August 30, 2012 of the efficacy and safety of peginterferon plus ribavirin therapy in CHC patients aged≥65 years were systematically identified in PubMed, Ovid, Web of Knowledge and Cochrane Library databases. A meta-analysis was performed using both fixed- and random-effects models based on heterogeneity across studies.
  
  
  RESULTS
  The overall sustained virological response (SVR) in CHC patients aged≥65 years was significantly lower than in patients aged<65 years on both intention-to-treat (ITT; 42.0% vs. 60.1%, respectively; P<0.00001) and per-protocol (PP; 54.4% vs. 67.4%, respectively; P=0.002) analyses, including treatment-naïve patients. Subgroup analysis showed that patients≥65 years with either hepatitis C virus (HCV) genotype 1/4 or 2/3 had lower SVR rates than younger patients. No statistically significant differences were observed between the two groups in terms of rapid virological response (RVR) and early virological response (EVR) rates (both P≥0.05). However, the end-of-treatment virological response (ETR) rate was lower in patients≥65 years, who also had a significantly higher risk of relapse than those aged<65 years (39.8% vs. 26.9%, respectively; P<0.00001). The discontinuation rate in the older patients was also significantly higher than in the younger patients (25.5% vs. 14.8%, respectively; P<0.00001). Ribavirin dose reduction in the older patients treated with peginterferon plus ribavirin was also significantly higher than in younger patients (44.5% vs. 32.8%, respectively; P<0.00001).
  
  
  CONCLUSIONS
  Peginterferon plus ribavirin therapy was effective for older patients with CHC, particularly those with HCV genotype 2/3. Response-guided therapy can be used for older patients with genotype 1/4, but such patients had poorer treatment adherence, leading to poorer treatment efficacy.
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China.
authors.forename: Zongguo
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Shanghai Medical College, Fudan University, Department of Oncology, 200032 Shanghai, PR China; Shanghai Cancer Center, Department of Integrative Medicine, 200032 Shanghai, PR China.
authors.forename: Liping
authors.initials: L
authors.lastname: Zhuang
authors.affiliation: The Central Hospital of China Aerospace Corporation, 100049 Beijing, PR China.
authors.forename: Lei
authors.initials: L
authors.lastname: Yang
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Liu
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China.
authors.forename: Qingnian
authors.initials: Q
authors.lastname: Xu
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China. Electronic address: xiaorong3chen@163.com.
authors.forename: Xiaorong
authors.initials: X
authors.lastname: Chen
authors.affiliation: Shanghai Public Health Clinical Center Affiliated to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508 Shanghai, PR China. Electronic address: chenliang65@fudan.edu.cn.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a