title: Age-related differences in response to peginterferon alfa-2a/ribavirin in patients with chronic hepatitis C infection.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of pegylated interferon alfa-2a and ribavirin therapy in elderly patients with chronic hepatitis C infection.
  
  
  METHODS
  Patients characteristics, treatment results and safety profiles of 4859 patients with hepatitis c virus (HCV) infection receiving treatment with pegylated interferon alfa-2a and ribavirin were retrieved from a large ongoing German multicentre non-interventional study. Recommended treatment duration was 24 wk for GT 2 and GT 3 infection and 48 wk for GT 1 and GT 4 infection. Patients were stratified according to age (< 60 years vs ≥ 60 years). Because of limited numbers of liver biopsies for further assessment of liver fibrosis APRI (aspartate aminotransferase - platelet ratio index) was performed using pre-treatment laboratory data.
  
  
  RESULTS
  Out of 4859 treated HCV patients 301 (6.2%) were ≥ 60 years. There were more women (55.8% vs 34.2%, P < 0.001) and predominantly GT 1 (81.4% vs 57.3%, P < 0.001) infected patients in the group of patients aged ≥ 60 years and they presented more frequently with metabolic (17.6% vs 4.5%, P < 0.001) and cardiovascular comorbidities (32.6% vs 6.7%, P < 0.001) and significant fibrosis and cirrhosis (F3/4 31.1% vs 14.0%, P = 0.0003). Frequency of dose reduction and treatment discontinuation were significantly higher in elderly patients (30.9% vs 13.7%, P < 0.001 and 47.8% vs 30.8%, P < 0.001). Main reason for treatment discontinuation was "virological non-response" (26.6% vs 13.6%). Sustained virological response (SVR) rates showed an age related difference in patients with genotype 1 (23.7% vs 43.7%, P < 0.001) but not in genotype 2/3 infections (57.7% vs 64.6%, P = 0.341). By multivariate analysis, age and stage of liver disease were independent factors of SVR.
  
  
  CONCLUSIONS
  Elderly HCV patients differ in clinical characteristics and treatment outcome from younger patients and demand special attention from their practitioner.
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Roeder
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Jordan
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Schulze Zur Wiesch
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Pfeiffer-Vornkahl
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Hueppe
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Mauss
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Zehnter
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Stoll
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Alshuth
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.affiliation: Claudia Roeder, Sabine Jordan, Julian Schulze zur Wiesch, Ansgar W Lohse, Stefan Lueth, Department of Medicine I, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Lueth
mesh_terms: D000367:Age Factors; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: Epidemiology; Geriatric; Hepatitis C virus infection; Non-interventional study; Older patients; Patients ≥ 60 years; Therapy