Z Gastroenterol 2012; 50 - P3_09
DOI: 10.1055/s-0031-1295851

Age above 60 years is not a negative predictive factor for combined antiviral therapy with pegylated interferon alpha and ribavirin in hepatitis C patients

P Frei 1, AK Leucht 1, U Held 2, R Kofmehl 2, M Rau 1, J Schmitt 1, T Gerlach 3, F Negro 4, M Heim 5, D Moradpour 6, A Cerny 7, JF Dufour 8, B Müllhaupt 1, A Geier 1
  • 1Department of Gastroenterology and Hepatology, Universitätsspital Zürich, Zürich, Switzerland
  • 2Horten-Zentrum, Universitätsspital Zürich, Zürich, Schweiz
  • 3Klinik Augustinum München, München
  • 4Departments of Internal Medicine and Pathology and Immunology, Divisions of Gastroenterology and hepatology and of Clinical pathology, University Hospitals, University of Geneva Medical Center, Geneva, Switzerland
  • 5Department of Biomedicine, Division of Gastroenterology and Hepatology, University Hospital Basel,, Basel, Switzerland
  • 6Medicine Department, Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  • 7Clinica Luganese Moncucco Lugano, Lugano, Switzerland
  • 8Institute of Clinical Pharmacology and Visceral Research, University of Bern, Bern, Switzerland

Aims: Age is frequently discussed as negative host factor to achieve a sustained virological response (SVR) to antiviral hepatitis C therapy. However, elderly patients often show relevant fibrosis as known negative predictive factor, making it difficult to interpret age as an independent predictive factor.

Methods: We analyzed data on hepatitis C therapy with PEG-interferon and ribavirin in 516 patients including 66 elderly patients ≥ 60 years. We analyzed host factors (age, gender, fibrosis, haemoglobin, depression, earlier hepatitis C treatment), viral factors (genotype, viral load) and treatment course. Generalised estimating equations (GEE) regression modelling was used for the primary end point (SVR), with age ≥ 60y and < 60y as independent variable and gender, cirrhosis, genotype, earlier treatment and viral load as confounders. SVR was analysed in young and elderly patients after matching for these confounders. Classification tree analysis was done using these confounders.

Results: GEE model showed that age had no influence on achieving SVR. After matching, SVR did not differ between age groups (54.2% in young and 55.9% in elderly patients, p=0.795). The classification tree-derived best criterion for SVR in elderly patients was genotype, with no further criteria relevant for predicting SVR in genotype 2/3. In patients with genotype 1/4, further criteria were presence of cirrhosis and low viral load <600’000 IE/ml in non-cirrhotic patients.

Conclusions: Age is not a relevant predictive factor for achieving SVR, when confounders are taken into account. Since life expectancy in Switzerland at age 60 is more than 22 y, hepatitis C therapy is reasonable in elderly patients with known relevant fibrosis or cirrhosis, because interferon-based hepatitis C therapy improves survival and reduces carcinogenesis.

HCV - PEG-interferon - elderly patients - ribavirin