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Sustained Virological Response of Antiviral Therapy and Clinical Outcomes in Elderly Patients with Compensated HCV - related Cirrhosis
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Reported by Jules Levin
AASLD Nov 1 2010
P.Charatcharoenwitthaya; R.Sermsathanasawadi; S.Chainuvati; N.Pausawasdi; S.Nimanong; V.Prachayakul; S.Pongprasobchai; S.Leelakusolvong; S.Manatsathit; U.Kachintorn; T.Tanwandee Medicine, Gastroenterology Division, Siriraj Hospital, Bangkoknoi, Bangkok, Thailand
Background & Aims: The clinical utility of antiviral therapy in elderly patients with HCV-related cirrhosis has not been elucidated. The aims of this retrospective study were 1) to evaluate whether antiviral therapy had similar benefits between patients with HCV-related cirrhosis aged 60 years and those aged < 60 years and 2) to clarify the long-term effect of antiviral therapy on life expectancy and risk of hepatocellular carcinoma (HCC) and liver failure defined as new onset of ascites, variceal bleeding, jaundice, or hepatic encephalopathy.
Methods: This study analyzed data on 194 consecutive patients with compensated HCV-related cirrhosis who received more than 1 year periodic medical screening from 1997 through 2009.
Results: A total of 159 cirrhotic patients (85 female and 74 male; mean age, 53.7+/-8.1 years) were treated with a combination of conventional interferon or
peginterferon and ribavirin; 36 of them (23%) were 60 years of age or older. The cohorts aged >/= 60 years had a median model of end-stage liver disease (MELD) score of 7 (range: 6-19); a median pretreatment viral load of 5.9 log10IU/L; and 61% were infected with HCV genotype 3. Clinical, hematologic, biochemical, and virological features were not different between patients aged >60 years and those aged < 60 years. Although the proportion of dose modification of antiviral agents was similar in both groups, sustained virological response (SVR) rates among patients aged >/=60 years were lower than those aged < 60 years (47% vs. 80%; p<.0001). Multivariate analysis showed that older age (p=.0002) and higher MELD score (p=.02) were associated with lower SVR while gender, HCV genotype and baseline viral load did not affect SVR. During a median follow-up of 56.5 months (range: 17-139), none of 17 elderly responders developed liver failure or died whereas 4 of 19 elderly nonresponders had liver failure and one of them died of cirrhotic complication. The annual incidence of HCC was 4.7% in elderly responders and 7.6% in elderly nonresponders. Comparison with patients aged 60 years who have never received antiviral therapy (n=35), SVR was found to be associated with a significant reduction in the risk of liver-related death (p=.04) and liver failure (p=.0008) but was not associated with a reduction in the risk of HCC development (p=.1) among elderly cirrhotic patients.
Conclusion: Although the efficacy of antiviral therapy among elderly patients with compensated HCV-related cirrhosis was inferior to that of young patients, achieving SVR in this population was associated with improved clinical outcomes, particularly prevention of decompensation of cirrhosis.
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