Z Gastroenterol 2009; 47 - P444
DOI: 10.1055/s-0029-1241688

Treatment of chronic hepatitis C with PegIFN-alfa2b and ribavirin within a large German multicentric observational study: response to therapy depends on patients' age

D Hüppe 1, E Zehnter 2, MP Manns 3, G Teuber 4, T Dahhan 5, S Kaiser 6, U Meyer 7, T Witthöfft 8, B Möller 7, N Dikopoulos 9, J Brack 10, M Bilzer 11, G Tossing 11 S Mauss 12, BNG Hepatitis Study Group
  • 1Medical Group Practice, Herne, Germany
  • 2Gastroenterological Practice, Dortmund, Germany
  • 3Medical High School Hannover, Hannover, Germany
  • 4Johann Wolfgang Goethe University, Frankfurt, Germany
  • 5Medical Practice, Backnang, Germany
  • 6University of Tübingen, Tübingen, Germany
  • 7Medical Practice, Berlin, Germany
  • 8University of Lübeck, Lübeck, Germany
  • 9University of Ulm, Ulm, Germany
  • 10Hospital Nord Ochsenzoll, Hamburg, Germany
  • 11Essex Pharma GmbH, Munich, Germany
  • 12Medical Group Practice, Duesseldorf, Germany

Aims: The current treatment of choice for hepatitis C is a combination of pegylated interferon-alfa (PegIFN-alfa) plus ribavirin. No age dependency of SVR has been described recently from the WIN-R cohort comparing patients older than 65 (SVR=46%) with those younger than 65 years (SVR=46%). A subgroup of patients between 18 to 25 years experienced higher SVR-rates of 57%. We evaluated the correlation of age and SVR within age decades 20 to 30 (group I), 30 to 40 (group II), 40 to 50 (group III), 50 to 60 (group IV) and 60 to 70 (group V) years, respectively.

Methods: Between 2003 and 2009, 279 sites treated a total of 4050 patients with PegIFN-alfa2b and ribavirin. The median age of the patients was 41.2±11.9 years. As this is an ongoing surveillance trial, we have performed an interim analysis of formerly untreated noncirrhotic patients with HCV-monoinfection (n=3248) regarding age-dependency of treatment outcome between genotypes (G) 1, 2, and 3. 2687 of these patients were evaluable for SVR (sustained virologic response after 6 months of follow-up). Data were analyzed using standard summary statistics and two-sided 95% confidence intervals. Because data were not available in all patients the number of patients fluctuates throughout the subgroups analyzed.

Results: While G3 is predominantly present in people younger than 40 years, G1 is the most common genotype in persons older than 40 years. However, nearly no difference is shown in G1 patients in age groups III and IV (SVR=43.3% and 43.1%, respectively). With growing age SVR rates declined in all genotypes while relapse rates increased. In addition, the rise in NR-rates is definitively more pronounced in G1 (16.7 to 45.1%) than in G3 (4.1 to 14.3%) from group I to V.

Conclusions: Persons under the age of 30 years have highest SVR-rates. As the rate of cirrhosis is continuously growing with age, it seems to be a factor which lowers response rates in the elderly. The prevalence of G1 in the elder and G3 in the younger population may be an epidemical finding. The drop in SVR rates according to age is more pronounced in G3 which seems to be due to the increase in relapse rather more than to an increase in primary NR. In G1, primary NR seems to play a major role as cause for decreasing SVR-rates.