By Liz Highleyman

Older age is associated with a lower likelihood of sustained response to pegylated interferon plus ribavirin in genotype 3 chronic hepatitis C patients, and people 50 years or older may benefit from longer treatment, according to a study presented at the recent Digestive Disease Week annual meeting (DDW 2009) in Chicago.

Hepatitis C virus (HCV) genotypes 2 and 3 are considered easier to treat than genotypes 1 or 4. Current guidelines recommend that patients with genotypes 2 or 3 should be treated with pegylated interferon (Pegasys or PegIntron) plus ribavirin for 24 weeks, while those with genotype 1 (and possibly 4) should receive 48 weeks of therapy and higher weight-adjusted doses of ribavirin.

However, as Xinyu Zhao and colleagues noted as background, some recent data suggest that the non-response rate for genotype 2 or 3 patients may be increasing -- reaching up to 20% -- and little is known about the factors associated with treatment failure.

The investigators conducted a retrospective chart review of medical records from 84 individuals (half men, half women) with HCV genotype 3 who were treated with pegylated interferon plus ribavirin between 2005 and 2007.

The participants' average age was 43 years and mean body weight was 80 kg. At baseline, the mean HCV RNA level was 5.8 log IU/mL and the mean alanine aminotransferase (ALT) level was 114.6 IU/dL. Patients were excluded if they were previously treatment-experienced, did not achieve good adherence, or were lost to follow-up.

HCV viral load and ALT were measured after 12 weeks (early virological response) and 24 weeks (end-of-treatment response) of therapy; HCV RNA was checked again 6 months after completion of treatment to determine sustained virological response (SVR).

Results

Overall, 54 patients (64.3%) achieved SVR, while 30 were non-responders or relapsers.

In a univariate analysis, age was found to be negatively associated with treatment response (odds ratio 0.78; P = 0.002).

Sex, body weight, baseline ALT, and baseline HCV RNA were not significantly associated with SVR, in contrast to some prior studies.

In a multivariate analysis adjusting for sex, body weight, and baseline ALT, age remained a significant predictor of poor treatment response (OR 0.64; P = 0.01).

Based on these findings, the researchers concluded, "Therapy response to interferon-based regimen in patients with HCV genotype 3 infection is negatively affected by increasing age, suggesting that elderly patients (> 50 years old) with genotype 3 infection may need longer duration of therapy."

Gastroenterology, Maimonides Medical Center, Brooklyn, NY; Gastroenterology and Hepatology, Coney Island Hospital, Brooklyn, NY.

6/16/09

Reference
X Zhao, MD Bernstein, K Iswara1, and others. Treatment Response Is Negatively Associated with Age in Genotype 3 Hepatitis C Virus Infection. Digestive Disease Week (DDW 2009). Chicago. May 30-June 4, 2009. Abstract M1802.