Elderly patients at greater risk of cytopenia during antiviral therapy for HCV

September 28, 2006

THE CANADIAN JOURNAL OF GASTROENTEROLOGY

September 2006, Volume 20, Number 9: 589-592

Elderly patients are at greater risk of cytopenia during antiviral therapy

for hepatitis C

CG Nudo, P Wong, N Hilzenrat, M Deschênes

The results of antiviral therapy for hepatitis C virus (HCV) have improved

recently with the use of pegylated interferon (PEG-IFN)/ribavirin (RBV)

combination therapy. At this point, most patients with chronic HCV remain

untreated. Thus, it is anticipated that therapy will be more appealing and

prescribed more broadly than in the past, including in patients considered

marginal.

AIM: To examine the effects of PEG-IFN-based antiviral therapy in elderly

patients with chronic HCV.

METHODS: The charts of patients treated with chronic HCV were reviewed.

Patients were defined as elderly if they were 60 years of age or older. The

control group consisted of patients younger than

60 years of age who were matched to the treated elderly patients based on

sex, treating physician, prescribed treatment and intended prescribed

treatment duration. The data recorded included end of treatment response,

sustained virological response (SVR), adverse events, dose modification and

withdrawal of therapy.

RESULTS: Thirty of 147 (20.4%) elderly patients attending a hepatitis C

clinic were treated. The average age of the elderly patients was 65±4 years.

Forty-three per cent were men and 57% were women. Ten per cent received IFN

monotherapy, 70% received a combination of IFN/RBV therapy and 20% received

a combination of PEG-IFN/RBV therapy. The overall response rates in the

elderly patients compared with the younger patients was 46.7% versus 65.8%

(P=0.11) for end of treatment response and 33.3% versus 51.2% (P=0.13) for

SVR. The rate of dose modification was 50% in the elderly patients compared

with 29% in the control group (P=0.08). Therapy was discontinued in 53% of

the elderly compared with 34% of younger patients (P=0.17). The younger

patients reported more side effects than elderly patients; although, there

were more laboratory abnormalities (anemia, thrombocytopenia and

neutropenia) in the elderly patients during therapy than in the younger

group (0.93 per patient versus 0.49 per patient, P=0.01).

CONCLUSION: Elderly patients with chronic HCV can be treated successfully.

However, they are more at risk to develop cytopenias while on treatment. In

such patients, the close monitoring of blood counts is necessary. Larger

studies are needed to confirm these findings and to determine whether SVR

differs in this population.

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September 28, 2006