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2017 ; 9
(5
): 252-262
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Efficacy and safety of telaprevir- and simeprevir-based triple therapies for
older patients with chronic hepatitis C
#MMPMID28261382
Yamagiwa S
; Ishikawa T
; Waguri N
; Sugitani S
; Wakabayashi H
; Ohkoshi S
; Tsukishiro T
; Takahashi T
; Watanabe T
; Terai S
World J Hepatol
2017[Feb]; 9
(5
): 252-262
PMID28261382
show ga
AIM: To evaluate and compare the efficacy and safety of telaprevir (TVR)-and
simeprevir (SMV)-based triple therapies in elderly patients, specifically
patients aged 66 years or older. METHODS: The present study enrolled 112 and 76
Japanese patients with chronic hepatitis C virus genotype 1b infection who were
treated with a 12-wk TVR-based or SMV-based triple therapy, respectively,
followed by a dual therapy that included pegylated interferon ? and ribavirin
(RBV) for 12 wk. The patients were categorized into two groups according to age
as follows: A younger group of patients aged ? 65 years old and an older group of
patients aged > 65 years old. Among the patients treated with TVR-based triple
therapy, 34 patients were included in the older group. The median ages were 56
years (range: 28-65 years) in the younger group and 69 years (range: 66-81 years)
in the older group. Among the patients treated with SMV-based triple therapy, 39
patients were included in the older group. The median ages were 59 years (range:
36-65 years) in the younger group and 71 years (range: 66-86 years) in the older
group. The clinical, biochemical and virological data were analyzed before and
during treatment. RESULTS: Among the patients treated with the TVR-based triple
therapy, no significant difference in the sustained virological response (SVR)
was found between the younger (80.8%) and older (88.2%) groups. The SVR rates for
patients with the interleukin 28B (IL28B) (rs8099917) TG/GG-genotypes (73.9% and
60.0% in the younger and older groups, respectively) were significantly lower
than for patients with the IL28B TT-genotype (86.3% and 92.9%, respectively). The
cumulative exposure to RBV for the entire 24-wk treatment period (as a percentage
of the target dose) was significantly higher in the younger group than in the
older group (91.7% vs 66.7%, respectively, P < 0.01), but the cumulative exposure
to TVR was not significantly different between the younger and older groups
(91.6% vs 81.9%, respectively). A multivariate analysis identified the
TT-genotype of IL28B (OR = 8.160; 95%CI: 1.593-41.804, P = 0.012) and the
adherence of RBV (> 60%) (OR = 11.052; 95%CI: 1.160-105.273, P = 0.037) as
independent factors associated with the SVR. Adverse events resulted in
discontinuation of the treatment in 11.3% and 14.7% of the younger and older
groups, respectively. Among the patients treated with the SMV-based triple
therapy, no significant difference in the SVR rare was found between the younger
(81.1%) and older (82.1%) groups. The SVR rates for patients with the IL28B
TG/GG-genotypes (77.8% and 64.7% in the younger and older groups, respectively)
were significantly lower than for patients with the IL28B TT-genotype (88.2% and
100%, respectively). A multivariate analysis identified the TT-genotype of IL28B
as an independent factor associated with the SVR (OR = 9.677; 95%CI:
1.114-84.087, P = 0.040). Adverse events resulted in discontinuation of the
treatment in 7.0% and 14.3% of patients in the younger and older groups,
respectively. CONCLUSION: Both TVR- and SMV-based triple therapies can be
successfully used to treat patients aged 66 years or older with genotype 1b
chronic hepatitis C. Genotyping of the IL28B indicates a potential to achieve SVR
in these difficult-to-treat elderly patients.