Triple therapy safe for elderly with chronic HCV

Triple therapy safe for elderly with chronic HCV
Triple therapy safe for elderly with chronic HCV

SAN FRANCISCO, CA —Telaprevir-based triple therapy is safe and effective in difficult-to-treat elderly patients with genotype 1 chronic hepatitis C virus (HCV), according to research presented at IDWeek 2013.

At 24 weeks after treatment, there was no significant difference in sustained virologic response (SVR) rates to triple therapy with telaprevir (Incivek, Vertex), peginterferon alfa and ribavirin among patients 60 years and older vs. younger patients (72.5% vs. 83.7%; P=0.14), Norihiro Furusyo, MD, PhD, from Kyushu University Hospital in Fukuoka, Japan, and colleagues reported at the meeting.

Previous studies have demonstrated improved SVR rates with telaprevir-based triple therapy compared with peginterferon alfa monotherapy and peginterferon alfa-2b and ribavirin dual therapy. Telaprevir, an HCV NS3/4A protease inhibitor, is indicated to treat chronic hepatitis C genotype 1 infection in combination with peginterferon alfa and ribavirin.

To examine whether age correlated with virological outcomes, Furusyo and colleagues enrolled 403 patients with genotype 1 chronic hepatitis C, of which 33.4% were treatment-naïve, 43.4% were prior relapsers, 18.9% were prior non-responders, and 4.2% with an unknown response.

Patients were then categorized into either Group A (age >60 years; n=64) or Group B (age <60 years; n=56) and  assigned to 12-week triple therapy regimen consisting of telaprevir 2250mg/day, peginterferon alfa-2b 60–150mcg/week, and ribavirin 600–1000mg/day followed by a 12-week peginterferon alfa-2b +ribavirin dual therapy.

Rapid virological response (RVR) was defined as undetectable HCV RNA at week 4. SVR was defined as undetectable serum HCV RNA at 24 weeks after the end of treatment.

There were no significant differences between the two groups in terms of RVR (75% vs. 77.5%) and SVR (72.5% vs. 83.7%; P=0.14), the researchers found.

For both groups, the SVR rate of interleukin 28B (IL28B) (rs8099917) TT (88.9% and 91.1% for Groups A and B, respectively) was significantly higher than IL28B TG/GG (46.2% and 45.8%; P<0.001).

Both IL28B TT (OR 8.8, P<0.01) and RVR (OR 13.2, P<0.01) were independently associated with achieving SVR, results of a multivariate analysis indicated.  

A total of 12.5% of patients in Group A and 10% in Group B discontinued treatment due to adverse effects. No episodes of death or hepatic decompensation were observed.

“IL28B genotyping and early virological response indicate effectiveness in these difficult-to-treat elderly patients,” Furusyo concluded.

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