Hirotoshi Ebinuma1, Hidetsugu Saito2,3, Shinichiro Tada1, Nobuhiro Nakamoto1, Tazuko Ohishi4, Satoshi Tsunematsu4, Naoki Kumagai4, Kanji Tsuchimoto4, Nobuhiro Tsukada5, Yasutaka Inagaki6, Yoshinori Horie7, Masahiko Takahashi8, Kazuhiro Atsukawa9, Yukishige Okamura10, Takanori Kanai1, Toshifumi Hibi1. 1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. 2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. hsaito@sc.itc.keio.ac.jp. 3. Department of Pharmacotherapeutics, Faculty of Pharmacy, Keio University, 1-5-30 Shiba-Kohen, Minato-ku, Tokyo, 105-8512, Japan. hsaito@sc.itc.keio.ac.jp. 4. The Center for Liver Diseases, Department of Internal Medicine, Kitasato Institute Hospital, Tokyo, Japan. 5. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saiseikai Central Hospital, Tokyo, Japan. 6. Department of Internal Medicine, Nihon Kohkan Hospital, Kawasaki, Japan. 7. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Eiju General Hospital, Tokyo, Japan. 8. Department of Gastroenterology and Hepatology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan. 9. Department of Gastroenterology and Hepatology, Hiratsuka City Hospital, Hiratsuka, Japan. 10. Department of Internal Medicine, Sanokousei Hospital, Sano, Japan.
Abstract
PURPOSE: Peginterferon (PEG-IFN) and ribavirin (RBV) combination treatment for patients with chronic hepatitis C (CHC), infected by genotype-1 hepatitis C virus with high viral loads, results in a sustained viral response (SVR) in ~50%. However, a trend of decreasing SVR in the older patients has been reported. In the present study, we verified this trend of treatment efficacy in older patients using the propensity score (PS). METHODS: We conducted a survey of 327 patients with CHC (genotype 1 and high viral loads) who were treated with PEG-IFN and RBV for 48 weeks. The SVR rate was compared between patients =60 and <60 years of age. Because backgrounds of these patients differed considerably, we verified this efficacy between the older (n = 102) and younger (n = 102) patients matched for gender, body weight, platelets (PLT), and red blood cell (RBC) counts using PS. RESULTS: The total SVR rate was 42.9% (161/327); this rate decreased with increasing age and was lower in the older patients (≥60 years: 41.5%, <60 years: 54.3%, P = 0.0245). Moreover, younger age was a significant factor for SVR. After correction by PS, the SVR in older patients remained significantly lower (≥60 years: 43.1%, <60 years: 57.8%, P = 0.0497). In addition, RBC counts and hemoglobin (Hgb) concentrations, as well as RBV adherence in the older patients, decreased with this treatment, although there were no significant differences in pretreatment RBC and Hgb levels. CONCLUSIONS: The analysis using PS indicated that RBV adherence in the older patients decreased even if they did not have lower pretreatment RBC and Hgb levels.
PURPOSE: Peginterferon (PEG-IFN) and ribavirin (RBV) combination treatment for patients with chronic hepatitis C (CHC), infected by genotype-1 hepatitis C virus with high viral loads, results in a sustained viral response (SVR) in ~50%. However, a trend of decreasing SVR in the older patients has been reported. In the present study, we verified this trend of treatment efficacy in older patients using the propensity score (PS). METHODS: We conducted a survey of 327 patients with CHC (genotype 1 and high viral loads) who were treated with PEG-IFN and RBV for 48 weeks. The SVR rate was compared between patients =60 and <60 years of age. Because backgrounds of these patients differed considerably, we verified this efficacy between the older (n = 102) and younger (n = 102) patients matched for gender, body weight, platelets (PLT), and red blood cell (RBC) counts using PS. RESULTS: The total SVR rate was 42.9% (161/327); this rate decreased with increasing age and was lower in the older patients (≥60 years: 41.5%, <60 years: 54.3%, P = 0.0245). Moreover, younger age was a significant factor for SVR. After correction by PS, the SVR in older patients remained significantly lower (≥60 years: 43.1%, <60 years: 57.8%, P = 0.0497). In addition, RBC counts and hemoglobin (Hgb) concentrations, as well as RBV adherence in the older patients, decreased with this treatment, although there were no significant differences in pretreatment RBC and Hgb levels. CONCLUSIONS: The analysis using PS indicated that RBV adherence in the older patients decreased even if they did not have lower pretreatment RBC and Hgb levels.
Entities:
Keywords:
Chronic hepatitis C; Propensity score; Ribavirin adherence; The combination treatment of peginterferon and ribavirin; The elderly patients
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