Treatment of Elderly Patients with Chronic Hepatitis C: A Retrospective Cohort Study

Abstract

The prevalence of chronic hepatitis C increases in elderly patients. The aims of this study were to identify the factors associated with hepatocellular carcinoma (HCC) and end-stage liver disease development and to evaluate the efficacy and safety of pegylated interferon (PEG-IFNα) plus ribavirin (RBV) therapy in elderly patients. A retrospective cohort study included all consecutive pa-tients with hepatitis C virus (HCV) infection treated with PEG-IFNα+RBV between 2003 and 2013. Elderly patients had a higher frequency of poor prognostic factors including genotype 1 infec-tion, high fibrosis, and high fibrosis index based on four factors (FIB-4) score. The sustained virologic response (SVR) rate for genotype 1 was significantly lower (35.8% vs. 57.1%), while the frequency of PEG-IFNα (27.2% vs. 7.8%), RBV dose reduction (19.6% vs. 9.7%) and treatment discontinuation (13.0% vs. 4.1%) was significantly higher in elderly patients. However, age was not associated with SVR in multivariate analysis, and comparable SVR rates were achieved when adjusted for fibrosis score (Ishak ≤3: 66.7% vs. 69.8%). During the follow-up, HCC was diagnosed in 18 elderly patients (3 SVR+, 4 SVR- and 9 untreated patients). In conclusion, selected elderly patients can achieve comparable SVR rates as younger patients, but with a higher rate of side effects. Since complications of HCV infection occur more frequently in elderly patients, they should be given priority for antiviral therapy.

Keywords: Aged; Antiviral agents; End stage liver disease; Hepatitis C – prognosis; Hepatitis C, chronic – treatment; Immunotherapy; Pegylated interferon alpha.

Fig. 1

Progression of liver disease in elderly patients as measured by APRI and FIB-4 score. Frequencies of HCV infected elderly patients (combined SVR negative and treatment naïve) in different APRI and FIB-4 stages at baseline, year 2 and year 4 of follow-up are shown. A significant increase in stage 3 FIB-4 score was recorded between baseline and year 2 (p=0.006, χ²-test) and year 4 (p=0.003). APRI: stage 1 <0.5, stage 2 ≥0.5<1.0, stage 3 ≥1.0; FIB-4: stage 1 <1.45, stage 2 ≥1.45<3.25, stage 3≥3.25. APRI = aspartate aminotransferase-to-platelet ratio index; FIB-4 = fibrosis index based on four factors