Interferon-free treatment regimens for chronic hepatitis C (HCV) in elderly patients are well tolerated and highly effective, according to study results published in the Annals of Hepatology.
The study included participants with chronic HCV from French general hospitals (n=1123). Participants were stratified into four groups according to age, with 278 aged ≥64 years (fourth quartile) and 133 ≥73 years (tenth decile).
The researchers found that compared with younger participants, elderly participants:
- weighed less
- were commonly treatment-experienced
- were likely to be women
- were often infected with genotype 1b or 2
- had more comorbidities
- had frequent drug consumption
Elderly participants were less likely to have chronic HCV genotype 3 or HIV co-infection compared with younger participants.
The most common treatment regimens were sofosbuvir/ledipasvir (37.8%), sofosbuvir/daclatasvir (31.8%), sofosbuvir/simeprevir (16.9%), and sofosbuvir/ribavirin (7.8%). In addition, 24% of patients were given ribavirin.
The results indicated that the overall sustained virologic response rate was 91.0% regardless of participant age. After performing logistic regression, the researchers found that albumin, hepatocellular carcinoma, and treatment regimens were independent predictors of sustained virologic response, but age was not.
Participants aged ≥64 years had a greater rate of severe adverse events (21/261, 8.1%) compared with the overall rate (66 in 59/1062, 5.6%). However, after logistic regression, cirrhosis and baseline hemoglobin were the only independent predictors of severe adverse events.
Overall, patient-reported tolerance was high in all age groups. Patient-reported fatigue decreased during and after treatment.
“This study suggests that age per se should not be considered a contraindication to antiviral treatment, however frailty, comorbidities and associated treatments should be carefully evaluated,” the researchers wrote.
Janssen and then Gilead funded the APROVVIE observatory, but had no role in analysis, interpretation of data and redaction, neither in the decision to submit this article for publication.
Pariente A, Arpurt J, Remy A, et al. Effects of age on treatment of chronic hepatitis C with direct acting antivirals. Ann Hepatol. 2019;18(1):193-202.