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DOI: 10.1055/s-0032-1323911
Alters- und geschlechtsbedingte Unterschiede bei SVR und Rezidiven nach Therapie der HCV-Genotyp 3-(G3)-Infektion mit Peginterferon Alfa-2b (Peg2b)/Ribavirin (RBV) in der Praxis
Aims: Because of the lack of new antiviral drugs, improvement of HCV G3 treatment can be achieved only by optimization of current standard therapy. Preliminary data suggest lower SVR rates for G3 infected elder patients. We therefore aimed to identify the contributing factors.
Methods: Within a multicenter observational study in Germany 1328 of 4061 patients with chronic hepatitis C were infected with G3. Of these, 1090 patients had documented treatment with Peg-IFNα-2b 1.5µg/kg/wk plus RBV (800–1200mg/day) for a median of 24 weeks and were included in this retrospective analysis. Patients were stratified according to baseline viral load, age, gender and platelet count.
Results: A SVR rate of 66.3% (723/1090) was estimated in the overall G3 population. SVR rates of 66.7% (371/556) and 66.6% (321/482) were not different in patients with low (<600.000 IU/ml) and high (≥600.000 IU/ml) baseline viral load. Patients ≥40 years achieved significantly (p=0.0002) lower SVR rates (59.5%, 245/412) than patients <40 years (70.5%, 478/678). This was related to a marked increase of relapse rates from 7.9 to 23.4% in young/elder patients while non-response rates remained comparable (6.8 vs. 10.7%). Interestingly, the decline in SVR was most prominent in elder male patients and accompanied by significantly higher relapse rates compared to female patients. In addition, there was a 2-fold higher proportion of low baseline platelet count <150 n/L in the male population suggesting that advanced fibrosis could in part contribute to the differences between female and male patients.
Age <40 years N=678 |
Age ≥40 years N=412 |
p |
|
SVR (%, n/N) Female Male |
72.0 (152/211) 69.8 (326/467) |
64.2 (95/148) 56.8 (150/264) |
0.1141 0.0004 |
Relapse (%, n/N) Female Male |
7.3 (12/164) 8.2 (29/355) |
15.2 (17/112)1 27.9 (58/208) |
0.0365 <0.0001 |
Non-response (%, n/N) Female Male |
7.1 (15/211) 6.6 (31/467) |
14.9 (22/148)2 8.3 (22/264) |
0.0174 0.3959 |
Platelets <150/nL (%, n/N) Female Male |
6.6 (14/211) 8.1 (38/467) |
12.8 (19/148)3 25.0 (66/264) |
0.0452 <0.0001 |
Male versus Female: 1 p=0.0105; 2 p=0.0395; 3 p=0.0034 |
Conclusions: In G3 patients older age affects SVR predominantly in male patients by higher relapse rates and not by primary non-response. This may be overcome by prolonged therapy and should stimulate individualized treatment strategies in older patients with G3 infection.
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Freitag, 21. September 2012/15:30–17:00/Saal 7