聚乙二醇干扰素 alfa-2b 联合利巴韦林治疗慢性丙型肝炎老年患者的适应证和局限性。
Indications and limitations for aged patients with chronic hepatitis C in pegylated interferon alfa-2b plus ribavirin combination therapy.
机构信息
Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.
出版信息
J Hepatol. 2011 Apr;54(4):604-11. doi: 10.1016/j.jhep.2010.07.043. Epub 2010 Dec 9.
BACKGROUND & AIMS: This study investigated the efficacy and adverse effects of pegylated interferon (Peg-IFN) plus ribavirin therapy in aged patients with chronic hepatitis C (CH-C).
METHODS
A total of 1040 naïve patients with CH-C (genotype 1, n=759; genotype 2, n=281), of whom 240 (23%) over 65 years old (y.o.), were treated with Peg-IFN alfa-2b plus ribavirin and assessed after being classified into five categories, according to age.
RESULTS
The discontinuance rate was higher for patients over 70 y.o. (36%), the most common reason being anemia. In the presence of genotype 1, the SVR rate was similar (42-46%) among patients under 65 y.o. and declined (26-29%) among patients over 65 y.o. For patients over 65 y.o., being male (Odds ratio, OR, 3.5, p=0.035) and EVR (OR, 83.3, p<0.001) were significant factors for SVR, in multivariate analysis. The Peg-IFN dose was related to EVR, and when EVR was attained, 76-86% of patients over 65 y.o. achieved SVR. SVR was not achieved (0/35, 0/38, respectively) if a 1-log decrease and a 2-log decrease were not attained at week 4 and week 8, respectively. In the presence of genotype 2, the SVR rate was similar (70-71%) among patients under 70 y.o. and declined among patients over 70 y.o. (43%).
CONCLUSIONS
Aged patients up to 65 y.o. with genotype 1 and 70 y.o. with genotype 2 can be candidates for Peg-IFN plus ribavirin therapy. The response-guided therapy can be applied for aged patients with genotype 1.
背景与目的
本研究旨在探讨聚乙二醇干扰素（Peg-IFN）联合利巴韦林治疗慢性丙型肝炎（CH-C）老年患者的疗效和不良反应。
方法
共纳入 1040 例初治 CH-C 患者（基因型 1，n=759；基因型 2，n=281），其中 240 例（23%）年龄>65 岁，根据年龄分为五组进行评估。
结果
70 岁以上患者停药率较高（36%），最常见的原因为贫血。在基因型 1 患者中，65 岁以下患者 SVR 率相似（42%-46%），而 65 岁以上患者 SVR 率下降（26%-29%）。对于 65 岁以上患者，男性（比值比，OR，3.5，p=0.035）和 EVR（OR，83.3，p<0.001）是 SVR 的显著相关因素，在多因素分析中。Peg-IFN 剂量与 EVR 相关，当达到 EVR 时，76%-86%的 65 岁以上患者达到 SVR。如果第 4 周和第 8 周分别未达到 1 个对数和 2 个对数下降，分别有 35 例（0/35）和 38 例（0/38）患者未达到 SVR。在基因型 2 患者中，70 岁以下患者 SVR 率相似（70%-71%），而 70 岁以上患者 SVR 率下降（43%）。
结论
年龄 65 岁以下基因型 1 和 70 岁以下基因型 2 的老年患者可作为 Peg-IFN 联合利巴韦林治疗的候选人群。对于基因型 1 的老年患者，可以采用基于应答的治疗策略。
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