Limitation of combination therapy of interferon and ribavirin for older patients with chronic hepatitis C
Limitation of combination therapy of interferon and ribavirin for older patients with chronic hepatitis C
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DOI：
10.1002/hep.20984
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发表时间：
2006-01-01
期刊：
影响因子：
13.5
通讯作者：
Shiratori, Y
中科院分区：
文献类型：
--
作者：
Iwasaki, Y;Ikeda, H;Shiratori, Y
与美国相反，目前接受干扰素治疗的日本慢性丙型肝炎患者年龄一般为10至15岁。然而，老年患者往往会经历更频繁的不良事件。本研究旨在阐明患者年龄对联合治疗疗效和安全性的影响。我们连续招募了208例初治慢性丙型肝炎患者。根据年龄将患者分为三组：50岁以下（n = 52）; 50至59岁（n = 83）; 60岁或以上（n = 73）。干扰素α-2b治疗每天给药2周，然后每周3次，持续22周，而利巴韦林每天给药。在208例研究患者中，116例（56%）需要停止治疗或减少剂量，老年患者组更常见：≥ 60岁患者组分别为38%、48%和77%（P < .001）。多变量分析显示患者年龄与治疗依从性独立相关。在77例（37%）患者中实现了持续的病毒学应答，基因型、病毒载量和治疗依从性与此成就相关。在老年患者中观察到持续病毒学应答率降低的趋势。总之，患者年龄是影响联合治疗安全性的一个重要因素。因此，对于老年慢性丙型肝炎患者，应调整治疗方案或考虑其他治疗方式。
In contrast to the United States, Japanese patients with chronic hepatitis C currently treated with interferon are generally 10 to 15 years older. Older patients, however, tend to experience more frequent adverse events. This study was conducted to clarify the effect of patient age on the efficacy and safety of combination therapy. We consecutively enrolled 208 patients with naive chronic hepatitis C. Patients were classified into three groups according to age: younger than 50 years of age (n = 52); 50 to 59 years old (n = 83); and 60 years of age or older (n = 73). Interferon alpha-2b therapy was administered daily for 2 weeks, followed by 3 times per week for 22 weeks, while ribavirin was administered daily. Of the 208 study patients, discontinuation of therapy or dose reduction was required in 116 (56%) and was more frequent in older patient groups: 38%, 48%, and 77% for the = 60-year-old patient groups, respectively (P < .001). Multivariate analysis showed patient age to be independently associated with adherence to therapy. A sustained virological response was achieved in 77 (37%) patients, with genotype, viral load, and adherence to therapy associated with this achievement. A tendency toward a lower sustained virological response rate was seen in the older patients. In conclusion, patient age is an important factor contributing to the safety of combination therapy. Thus, treatment schedule should be modified, or other therapeutic modalities should be considered for older patients with chronic hepatitis C.