Department of Medicine, Armed Forces Capital Hospital, Seongnam, South Korea.
J Gastroenterol Hepatol. 2011 Mar;26(3):469-76. doi: 10.1111/j.1440-1746.2010.06478.x.
In the present study, we evaluated the safety and efficacy of combination therapy with pegylated interferon and ribavirin for treating chronic hepatitis C (CHC) patients aged 60 years and older.
A total of 314 CHC patients, who were treated with combination therapy, were classified into three groups according to age: (i) younger than 50 years (n = 137); (ii) 50-59 years (n = 109); and (iii) 60 years or older (n = 68). The sustained virological response (SVR) and discontinuation rates were compared between the three groups.
Discontinuation of therapy due to adverse event was more frequent in the older patient groups: 1%, 5%, and 10% for the < 50-year, the 50-59-year, and the ≥ 60-year patient groups, respectively (P = 0.018). However, the older patient groups showed a SVR rate that was comparable to the SVR rates of the other age groups: 80%, 73%, and 75% for the < 50-year, 50-59-year, and ≥ 60-year- patient groups, respectively (P = 0.420). A multivariate analysis showed that the aspartate aminotransferase : platelet ratio index (APRI) was an independent predictor of an SVR. An SVR was achieved in 95% (19/20) of the elderly patients with an APRI < 0.80.
Although physicians must pay more attention to adverse events in the older patients, combination therapy can be considered for older patients, especially for patients with a low APRI.
在本研究中,我们评估了聚乙二醇干扰素联合利巴韦林治疗 60 岁及以上慢性丙型肝炎(CHC)患者的安全性和疗效。
共 314 例接受联合治疗的 CHC 患者根据年龄分为三组:(i)<50 岁(n = 137);(ii)50-59 岁(n = 109);和(iii)60 岁或以上(n = 68)。比较三组患者的持续病毒学应答(SVR)和停药率。
由于不良事件而停止治疗的患者在老年患者中更为常见:<50 岁、50-59 岁和≥60 岁患者组的发生率分别为 1%、5%和 10%(P = 0.018)。然而,老年患者组的 SVR 率与其他年龄组的 SVR 率相当:<50 岁、50-59 岁和≥60 岁患者组的 SVR 率分别为 80%、73%和 75%(P = 0.420)。多变量分析显示,天冬氨酸氨基转移酶:血小板比值指数(APRI)是 SVR 的独立预测因子。APRI<0.80 的老年患者中,95%(19/20)达到 SVR。
尽管医生必须更加关注老年患者的不良反应,但可以考虑为老年患者提供联合治疗,特别是对于 APRI 较低的患者。