Glecaprevir/Pibrentasvir for Elderly Patients with HCV

Glecaprevir/pibrentasvir therapy is effective and well tolerated in patients aged > 75 years with hepatitis C virus (HCV) infection, according to a retrospective study published in Geriatrics & Gerontology International.¹

Because of an increasingly longer lifespan, the number of older patients with HCV infection has also increased; however, these patients are less likely to receive antiviral treatments especially those containing interferon, due to comorbidities and poor tolerability.¹ Studies have shown that direct-acting antivirals (DAAs) are effective and safe in older patients with HCV infection.^2-4 Glecaprevir/pibrentasvir is a pangenotypic DAA combination therapy that has demonstrated high sustained virologic response rates with favorable safety in patients with chronic HCV infection infection.^5-8

Few studies have evaluated this therapy in patients with HCV infection aged > 75 years, therefore researchers in Japan compared 43 HCV patients aged > 75 years with 88 HCV patients < 75 years, all of whom received treatment with glecaprevir/pibrentasvir.¹

Among patients aged > 75 years, researchers found the presence of cirrhosis in 27.9%, a history of hepatocellular carcinoma in 23.3%, and comorbidities in 88.4%; compared with 12.5%, 2.3% and 69.5%, respectively. In the intention-to-treat population, 86.0% in the aged > 75 years group and 78.4% in < 75 years group demonstrated sustained virologic response at 12 weeks after treatment (P = .30); this demonstrated a nonsignificant difference in treatment effectiveness between the 2 group.

Overall, 27.5% of the study cohort experienced adverse events, the most frequent of which was pruritus; adverse events occurred significantly more commonly among women, in the presence of hemodialysis, and serum albumin at baseline < 4.0 g/dL.

The study authors concluded that, “Glecaprevir/pibrentasvir therapy was effective and well tolerated, even in elderly patients with hepatitis C virus infection aged ≥75 years.”¹

References

1. Kinoshita A, Koike K, Mizuno Y, et al. Efficacy and safety of glecaprevir/pibrentasvir in patients with hepatitis C virus infection aged ≥75 years [published online April 8, 2020]. Geriatr Gerontol Int. doi:10.1111/ggi.13919.
2. Saab S, Park SH, Mizokami M et al. Safety and efficacy of ledipasvir/sofosbuvir for the treatment of genotype 1 hepatitis C in subjects aged 65 years or older. Hepatology. 2016;63:1112-1119.
3. Su F, Beste LA, Green PK, Berry K, Ioannou GN. Direct-acting antivirals are effective for chronic hepatitis C treatment in elderly patients: a real-world study of 17487 patients. Eur J Gastroenterol Hepatol. 2017;29:686-693.
4. Lens S, Fernandez I, Rodriguez-Tajes S et al. Interferon-free therapy in elderly patients with advanced liver disease. Am J Gastroenterol. 2017;112:1400-1409.
5. Kwo PY, Poordad F, Asatryan A et al. Glecaprevir and pibrentasvir yield high response rates in patients with HCV genotype 1-6 without cirrhosis. J Hepatol. 2017;67:263-271.
6. Zeuzem S, Foster GR, Wang S et al. Glecaprevir-Pibrentasvir for 8 or 12 weeks in HCV genotype 1 or 3 infection. N Engl J Med. 2018;378:354-369.
7. Chayama K, Suzuki F, Karino Y et al. Efficacy and safety of glecaprevir/pibrentasvir in Japanese patients with chronic genotype 1 hepatitis C virus infection with and without cirrhosis. J Gastroenterol. 2018;53:557-565.
8. Toyoda H, Chayama K, Suzuki F et al. Efficacy and safety of glecaprevir/pibrentasvir in Japanese patients with chronic genotype 2 hepatitis C virus infection. Hepatology. 2018;67(2):505-513.