Necessities of interferon therapy in elderly patients with chronic hepatitis C

Abstract

Background: The significance of antiviral therapy for elderly patients with chronic hepatitis C virus (HCV) infection has not been elucidated.

Patients and methods: Among 5645 patients with HCV-related chronic liver disease, the prognosis of 1917 elderly patients aged 60 years or more was analyzed. A total of 454 patients underwent interferon (IFN) therapy. By using multivariate analysis, carcinogenesis and survival were analyzed according to initial findings.

Results: At 10 and 15 years, cumulative survivals in untreated elderly patients were 90.7% and 72.7% in the high platelet (>or=150,000/mm(3)) group, 78.6% and 47.8% in the intermediate (100,000-149,000/mm(3)) group, and 52.5% and 25.0% in the low platelet group (<100,000/mm(3)), respectively. At 5 and 10 years, hepatocarcinogenesis rates in the intermediate and low platelet groups were 10.9% and 21.6% in the IFN group (N=217) and 19.5% and 43.0% in the untreated group (N=459), respectively (P=.0005). IFN independently decreased carcinogenesis risk with a hazard ratio of 0.56 (P=.035). In the high platelet group, 5- and 10-year carcinogenesis rates were 3.7% and 8.3% in the IFN-treated group (N=228) and 5.1% and 14.0% in the untreated group (N=585), respectively (P=.69). IFN treatment significantly increased cumulative survivals in the lower platelet subgroup (P=.0001) but did not affect the higher platelet subgroup (P=.08). IFN was independently associated with a longer survival in the lower platelet subgroup (hazard ratio 2.33, P=.005).

Conclusion: In elderly patients with chronic HCV, IFN for a subgroup with intermediate and low platelet counts had significant advantages in regard to hepatocarcinogenesis and survival.