Commentary: efficacy and safety of ribavirin plus pegylated interferon-alpha in geriatric patients with chronic hepatitis C – authors’ reply

Authors


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[3] and 18% in France[4]). Second, there is a high rate of progression of fibrosis in elderly patients with chronic HCV[4] 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.[5]

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.

Acknowledgement

The authors’ declarations of personal and financial interests are unchanged from those in the original article.2

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