Digestive Diseases and Sciences. 2008 Mar;53(3):809-14. Epub 2007 Sep 1.
Treatment eligibility and outcomes in elderly patients with chronic hepatitis C: results from the VA HCV-001 Study.
Tsui JI, Currie S, Shen H, Bini EJ, Brau N, Wright TL; VA HCV-001 Study Group.
Collaborators (22)Moseley R, Hagedorn C, Johnson D, Pedrosa M, Aytaman A, Mendenhall C, Anand B, King P, Simon F, Schmidt W, Hu KQ, Morgan T, Waters B, Jeffers L, Ho S, Awad J, Cheung R, Chang KM, Ahmad J, Sasaki A, Strader D, Hirsch K./p>
Significance:
As patients with chronic hepatitis C virus (HCV) infection continue to age, we anticipate having a large number of elderly patients 60 years of age and older who are chronically infected.
Although treatment candidacy, tolerability of interferon and ribavirin therapy, and treatment outcomes have been well described in young patients with chronic HCV infection, clinical trials have excluded elderly patients and, therefore, little is know about HCV infection is this population.
In a large multicenter study of over 4,000 HCV-infected patients, we showed that elderly patients were less likely than younger patients to be a treatment candidate or to receive treatment. However, those that were treated had similar outcomes as younger patients in terms of tolerability and sustained virologic response rates.
Abstract:
OBJECTIVES: We undertook this study to determine if treatment candidacy and outcomes were similar between elderly and non-elderly patients.
METHODS: This was a prospective cohort study that screened 4,025 patients with chronic hepatitis C for HCV antiviral treatment at 24 Veterans Affairs Medical Centers throughout the country. We used multivariable logistic regression to determine whether there was an independent association between being elderly (age > 60 vs. <or= 60) and (1) being considered a treatment candidate by clinician, and (2) achieving sustained virologic response if treated.
RESULTS: 364 of the 4,025 patients (9%) were over the age of 60. Only 25% of patients over the age of 60 were considered to be treatment candidates by the evaluating clinician, and only 10% were started on treatment. After adjustment for potential confounders, older age remained associated with a lower likelihood of being considered a treatment candidate (adjusted OR = 0.43; 95% CI: 0.30-0.61). Although based on a small sample of elderly treated patients (n = 35), being elderly did not appear to be associated with a lower likelihood of achieving SVR (adjusted OR = 1.54; 95% CI: 0.46-5.15).
CONCLUSION: Among veterans over the age of 60 with chronic hepatitis C who are referred for treatment, relatively few are considered treatment candidates and an even smaller number are ultimately treated. After adjusting for co-morbidities, age remains a strong predictor of not being a treatment candidate. In contrast, older age does not seem to adversely affect treatment outcomes and side effects.
PMID: 17823868
