The study below is interesting because it explores
the difficulties that people 65 years and older experience with
pegylated interferon plus ribavirin therapy—more side effects and lower
efficacy. If someone is considering treatment this information should
definitely be factored into the treatment decision process when
considering if it is safe (or not) to wait for newer medications that
have less side effects and higher cure rates. –Alan Franciscus
Efficacy and safety of
peginterferon plus ribavirin for patients aged ≥ 65 years with chronic
hepatitis C: A systematic review and meta-analysis.
Yang Z, Zhuang L, Yang L, Liu C, Lu Y, Xu Q, Chen X, Chen L.
Shanghai Public Health Clinical Center Affiliated
to Fudan University, No. 2901, Caolang Rd, Jinshan District, 201508
Shanghai, PR China.
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
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%,
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.
Copyright © 2013 Elsevier Masson SAS. All rights reserved.
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