DAAs Effective for Chronic HCV, Even in Very Elderly

DAAs Effective for Chronic HCV, Even in Very Elderly
DAAs Effective for Chronic HCV, Even in Very Elderly

BOSTON, MA—“Advanced age in and of itself should not be considered a barrier to direct-acting antiviral (DAA) treatment” in patients with chronic hepatitis C virus (HCV) infection, a study in more than 17,000 veterans presented at The Liver Meeting® 2016 concluded.

“DAAs are equally highly effective for the treatment of chronic HCV in all age groups, including very elderly patients,” added Feng Su, MD, University of Washington, Seattle, WA and Veterans Affairs Puget Sound Healthcare System, Seattle, WA, and colleagues.

“The cohort of HCV-infected patients in the United States is aging” and, in the past, elderly patients have poorly tolerated interferon-based treatments, she noted. Although the newer DAAs “have high efficacy and excellent safety profiles, elderly patients are underrepresented in clinical trials of DAAs.”

To compare the real-world effectiveness of DAAs among patients with chronic HCV in different age groups, Dr. Su and colleagues evaluated 17,487 patients in the Veterans Affairs national healthcare system who initiated treatment with sofosbuvir (SOF), ledipasvir/sofosbuvir (LDV/SOF), and paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD) regimens between January 1, 2014, and June 30, 2015. SVR was defined as viral load below lower limit of quantification ≥12 weeks after treatment completion. 

Baseline characteristics and rates of sustained virologic response (SVR) were assessed in patients aged <55 years (1903; 10.9%); 55–<60 years (4441; 25.5%); 60 to <65 years (6291; 36.1%); 65–<70 years (4106; 23.6%); 70–<75 years (507; 1.2%); and ≥75 years (174; 1.0%). Mean age was 60.8 years (± 6.5) and median age was 61 years.

“Distributions of genotypes and treatment regimens were similar between age groups,” the investigators found.

Cirrhosis was increasingly common with increasing age, and ranged from 20.3% in patients aged <55 years to 36.2% in patients ≥75 years.

Among all patients, they found overall SVR rate to be 90.7% (95% CI: 90.2, 91.1). This rate was similarly high regardless of age: <55 years (91.2%, 95% CI: 89.7, 92.4), 55–<60 (89.8%, 95% CI: 88.8, 90.7), 60–<65 (90.8%, 95% CI: 90.1, 91.6), 65–<70 (91.1%, 95% CI: 90.1, 91.9), 70–<75 (90.0%, 95% CI: 86.9, 92.4) and ≥75 years or older (93.8%, 95% CI: 88.8, 96.7).

No major differences in unadjusted SVR rates were observed between age groups regardless of genotype, stage of liver disease, and prior treatment experience.

“In multivariable regression models, age was not predictive of likelihood of achieving SVR after adjusting for baseline characteristics including genotypes (1, 2 3), regimen, cirrhosis, decompensated cirrhosis, and prior treatment experience,” Dr. Su concluded. "It is reasonable to consider elderly patients for HCV treatment." 

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