DAA Therapy Highly Efficacious for HCV Treatment in Older Adults

Direct-acting antiviral (DAA) therapy is highly efficacious for the treatment of hepatitis C virus (HCV) infection in individuals >65 years; however, those ³75 years are more likely to be at risk for significant drug-drug interactions and experience adverse events during therapy, according to a retrospective study published in the Journal of the American Geriatrics Society.¹

Multiple studies have demonstrated that DAA therapy is extremely well tolerated and highly efficacious for the treatment of HCV.^2-5 Although only a limited number of participants in these trials are aged 65 and older, in clinical practice, older adults are 1 of the largest cohorts being treated at viral hepatitis clinics and often have more advanced liver disease, a greater risk for liver cancer, more comorbidities, and a greater likelihood of polypharmacy than younger adults.^6-8

Thus, researchers assessed the efficacy and tolerability of DAA therapy for HCV infection in 113 adults aged 65 years and older (n=88 for those 65-74 years old; n=25 for those ³75 years old) who started DAA treatment at a single center in the United Kingdom.¹

They found that the sustained virologic response rate was 97.7% in individuals aged 65 to 74 years and 95.8% in those aged ³75 years. Compared with individuals aged 65 to 74 years, individuals aged ³75 years were more likely to be taking more than 2 medications per day for chronic conditions and more likely to be at risk for clinically significant drug-drug interactions that required cessation or adjustment of medications before starting DAA therapy.

In addition, individuals ³75 years old were more likely to experience an adverse event during therapy and were more susceptible to developing anemia secondary to ribavirin compared with individuals between 65 and 74 years old.

“To conclude, our data demonstrate an excellent SVR rate with DAA therapy in older adults who had high rates of cirrhosis and comorbidities,” stated the authors.¹

References

1. Mazzarelli C, Considine A, Childs K, et al. Efficacy and tolerability of direct‐acting antivirals for hepatitis C in older adults [published online May 25, 2018]. J Am Geriatr Soc. doi: 10.1111/jgs.15392
2. Zeuzem S, Dusheiko GM, Salupere R, et al. Sofosbuvir and ribavirin in HCV genotypes 2 and 3. N Engl J Med. 2014;370:1993-2001.
3. Kowdley K, Gordon SC, Reddy KR, et al. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med. 2014;370:1879-1888.
4. Nelson DR, Cooper JN, Lalezari JP, et al. All-oral 12-week treatment with daclatasvir plus sofosbuvir in patients with hepatitis C virus genotype 3 infection: ALLY-3 phase III study. Hepatology. 2015;61:1127-1135.
5. Younossi ZM, Stepanova M, Henry L, Nader F, Hunt S. An in-depth analysis of patient-reported outcomes in patients with chronic hepatitis C treated with different anti-viral regimens. Am J Gastroenterol. 2016;111:808-816.
6. Vespasiani-Gentilucci U, Galati G, Gallo P, De Vincentis A, Riva E, Picardi A. Hepatitis C treatment in the elderly: New possibilities and controversies towards interferon-free regimens. World J Gastroenterol. 2015;21:7412-7426.
7. Pradat P, Voirin N, Tillmann HL, Chevallier M, Trépo C. Progression to cirrhosis in hepatitis C patients: An age-dependent process. Liver Int. 2007;27:335–9.
8. Poynard T, Ratziu V, Charlotte F, Goodman Z, McHutchison J, Albrecht J. Rates and risk factors of liver fibrosis progression in patients with chronic hepatitis C. J Hepatol. 2001;34:730-739.