We appreciate the comments of Professors Hadziyannis and Sevastianos on our study concerning efficacy and safety of ribavirin plus pegylated interferon in geriatric patients with chronic hepatitis C.[1, 2]
We totally agree with their opinions that chronic hepatitis C virus (HCV)-infected geriatric patients (age ≥ 65 years) with significant hepatic fibrosis should be treated with ribavirin (RBV) plus pegylated interferon (pegIFN) therapy. The reasons for this are clear. First, there is a high anti-HCV positive rate in those older than 65 year (7.8% in Taiwan and 18% in France). Second, there is a high rate of progression of fibrosis in elderly patients with chronic HCV infection (cirrhosis development 63% vs. 2% in those infected HCV >50 or <20 years old respectively). Third, there is a high (2–8%) risk of hepatocellular carcinoma(HCC) occurrence after cirrhosis development.
In view of the increasing life span of geriatric patients, aggressive anti-viral therapy should be considered to avoid adverse sequelae such as cirrhosis or HCC development. However, there are limited efficacy data for RBV plus pegIFN in treating chronic HCV-infected geriatric patients because almost all clinical trials excluded geriatric patients.
Our data indicate that the sustained virological response rate (SVR) was slightly lower in geriatric patients compared with middle-aged patients (41% vs. 62%, P = 0.005), but there was no difference in withdrawal rate between both groups (13.2% in elderly group vs. 7.7% in younger group). However, 41% SVR and 13% withdrawal rate are not satisfactory for geriatric patients.
Recently, the novel therapies using direct-acting anti-viral agents (DAAs) have achieved a high rate of SVR in genotype-1 infected naïve or previous null-responders.[6, 7] In addition, the new approach to HCV therapy with dual or more DAAs without pegIFN[8-10] (IFN-free therapy) may further improve the therapeutic efficacy, and has less adverse effects, with greater convenience for geriatric patients to use.