Efficacy and Tolerability of Direct‐Acting Antivirals for Hepatitis C in Older Adults

Mazzarelli, Chiara; Considine, Aisling; Childs, Kate; Carey, Ivana; Manini, M.A.; Suddle, Abid; Dusheiko, Geoffrey; Cannon, Mary

doi:10.1111/jgs.15392

Cited by 9 publications

(8 citation statements)

References 43 publications

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“…In line with the standard numerical criterion of the United Nations, China uses a cutoff is 60+ years to refer to the elderly, which is equivalent to the legal retirement age (27). Previous studies on the efficacy of DAA therapy for older patients have mainly been based on different age groups, and the results are similarly highly efficient (17)(18)(19)32). Our study also showed that patients in three age subgroups (i.e., the age groups of 60-69, 70-79, and ≥80) had excellent SVR results.…”

Section: Discussionsupporting

confidence: 70%

“…To date, these questions remain unanswered, as the data are limited, which is mainly due to the fact that older patients are usually excluded or underrepresented in clinical trials (3). Further, the majority of real-world studies that have examined the treatment outcomes and safety of DAA therapy among older HCV patients have been conducted in Western countries (14)(15)(16)(17)(18); thus, the data for Asian countries are very limited (19,20). Additionally, these studies (I) focused on only one DAA regimen (14,21), (II) considered only one HCV genotype (15,20,22), or (III) lacked power due to their limited sample sizes (16,19).…”

Section: Introductionmentioning

confidence: 99%

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Direct-acting antiviral treatments display excellent outcomes even in older HCV-infected patients at increased risk of fibrosis

et al. 2021

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Background: This study compared the efficacy and tolerability of available direct-acting antiviral (DAA) regimens between individuals aged 60 years and older and younger patients in a real-life setting. Specifically, we aimed to provide evidence of the efficacy and safety of DAAs in the treatment of older adults in Tianjin, China.Methods: In this retrospective observational cohort study, patients with chronic hepatitis C virus (HCV) were enrolled between April 2018 and December 2019 at 2 tertiary hospitals in Tianjin, China. We assessed the sustained virologic response (SVR) 12 weeks (SVR12) after DAA treatment, and adverse events in two groups using age stratification by comparing older adults (≥60 years) and younger adults (<60 years). Logistic regression analyses were performed to explore the risk factors associated with the SVR12. Results: Of 1,106 patients, 440 (39.8%) were ≥60 years of age. The overall SVR12 rate was 97.8% in the entire cohort. In the older adult group, the SVR12 rate was 98.0% (431/440) compared to 97.7% (651/666) in the younger adult group. A multivariate analysis showed that (I) age was not predictive of SVR; and (II) the variables of treatment-experience [adjusted odds ratio (aOR) =27.53; 95% confidence interval (CI) =3.35-226.08; P=0.002] and aspartate aminotransferase (AST) (aOR =1.02; 95% CI =1.01-1.04; P=0.027)were independently associated with the SVR12 in the older adult group. All of the available DAA regimens were well-tolerated in older adult group.Conclusions: Chinese older adults with chronic HCV infection showed a significantly higher percentage of fibrosis; however, the available different DAA regimens were safe, well-tolerated, and achieved high rates of SVR in all age subgroups. Our observations suggest that DAA treatment should not be withheld even from older patients suffering from chronic HCV.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Direct-acting antiviral treatments display excellent outcomes even in older HCV-infected patients at increased risk of fibrosis

et al. 2021

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“…Little is known about the course of HCV infection in this older population. Early reports suggest similar efficacy of direct-acting antiviral (DAA) therapy in older patients but increased risk of adverse events in those over the age of 75 [12]. Given the rarity of documented risk factors in this cohort, it is unclear how and when the majority of these patients were initially infected.…”

Section: Discussionmentioning

confidence: 95%

Preliminary Screening Results Outside the 1945–1965 Birth Cohort: A Forgotten Population for Hepatitis C?

Winetsky

Zucker

Słowikowski

et al. 2019

Open Forum Infectious Diseases

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“…Elderly people often experience multi-morbidities (either due to aging or to HCV itself), take comedications, and most likely also have a long history of hepatic disease, even for the risk factors associated with the infection in Italy [2]. All these characteristics (advanced age, comorbidities, and high burden of comedications) could potentially affect tolerability of HCV treatment and adherence in this subgroup [7]. Moreover, some possible side effects and biomarker alterations, as well as increased risk of liver cancer, have been reported by several authors, especially in elderly people [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

et al. 2020

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Background and objectives: In Italy, Hepatitis C Virus (HCV) infections are most prevalent in people older than 50 years of age, who often experience multi-morbidities, take co-medications, and have a long history of liver disease. These characteristics could potentially affect tolerability of HCV treatments and adherence in this subgroup. After achievement of sustained virological response (SVR), retention into care is very important both to detect the onset of possible complications and prevent further infections. In this study, SVR rates and retention into care of patients treated with directly acting antivirals (DAAs) of a single-center cohort in Southern Italy were evaluated. Materials and Methods: Patients treated with directly acting antivirals from 2014 to 2018 were included. Patients were stratified by age (i.e., <65 vs. ≥65 years) and by cirrhosis presence (i.e., liver stiffness >14.6 KPa or clinical/ultrasound cirrhosis vs. absence of these criteria). Primary outcome was availability of SVR at Weeks 12-24 after the end of treatment. Inter-and intra-group comparisons were performed along the follow-up for significant laboratory parameters. Results: In total, 212 patients were treated; 184 (87%) obtained SVR after the first treatment course and 4 patients after retreatment. Twenty-two (10.4%) patients were lost to follow-up before assessment of SVR, and two patients died before the end of treatment for liver decompensation. Considering only the first treatment episode, per protocol analysis (i.e., excluding patients lost to follow-up) showed the following rates of SVR: 97% (overall), 97% (older age group), 96% (age group <65 years), 94% (cirrhotics), and 100% (non-cirrhotics). By contrast, at the intention to treat analysis (i.e., patients lost were computed as failures), SVR percentages were significantly lower for patients <65 years of age (80%) and for non-cirrhotics (85%). Conclusions: High rates of SVR were obtained. However, younger patients and those without cirrhosis displayed an apparent high risk of being lost to follow-up. This may have important implications: since those who are lost may transmit HCV in case SVR is not achieved, these subpopulations should receive appropriate counselling during treatment.

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Efficacy and Tolerability of Direct‐Acting Antivirals for Hepatitis C in Older Adults

Abstract: DAA therapy is highly efficacious for the treatment of HCV in older adults, but those aged 75 and older are more likely to have clinically significant pretreatment DDIs and experience AEs, including ribavirin-induced anemia, during therapy.

Cited by 9 publications

References 43 publications

Direct-acting antiviral treatments display excellent outcomes even in older HCV-infected patients at increased risk of fibrosis

Direct-acting antiviral treatments display excellent outcomes even in older HCV-infected patients at increased risk of fibrosis

Preliminary Screening Results Outside the 1945–1965 Birth Cohort: A Forgotten Population for Hepatitis C?

Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

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