High Effectiveness of Direct Antiviral Agents for Hepatitis C Virus Infection in Elderly Patients in a National Healthcare System
AASLD LiverLearning®. Ioannou G. Nov 14, 2016; 144832
Topic: Treatment
Dr. George Ioannou
Dr. George Ioannou
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TITLE: High Effectiveness of Direct Antiviral Agents for Hepatitis C Virus Infection in Elderly Patients in a National Healthcare System

Merit Review grants (I01CX000320 and I01CX001156), Clinical Science Research and Development, Office of Research and Development, Veterans Affairs (GNI).

Background and Aims
The cohort of HCV-infected patients in the United States is aging. Previous interferon-based treatments for chronic hepatitis C virus (HCV) infection were poorly tolerated in elderly patients. New direct antiviral agents (DAAs) have high efficacy and excellent safety profiles but elderly patients are underrepresented in clinical trials of DAAs. We aimed to compare the real-world effectiveness of DAAs among patients in different age groups, including elderly patients, in a national healthcare system.

We evaluated 17,487 patients with chronic HCV in the Veterans Affairs national healthcare system who initiated treatment with sofosbuvir (SOF), ledipasvir/sofosbuvir (LDV/SOF), and paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD) based regimens between January 1, 2014 and June 30, 2015. We assessed baseline characteristics and rates of sustained virologic response (SVR) in patients aged < 55 years, 55 to < 60, 60 to < 65, 65 to < 70, 70 to < 75, and 75 years or older.

The mean age of antiviral treatment recipients was 60.8 years (+/- 6.5) and median age was 61 years. 1,903 (10.9%) were aged <55 years, 4,441 (25.5%) were aged 55 to < 60, 6,291 (36.1%) were aged 60 to <65, 4,106 (23.6%) were aged 65 to < 70, 507 (1.2%) were aged 70 to < 75, and 174 (1.0%) were aged 75 years or older. The distributions of genotypes and treatment regimens were similar between age groups. Cirrhosis was increasingly common with increasing age ranging from 20.3% in patients aged <55 years to 36.2% in patients ≥75 years. Overall SVR rate was 90.7% (95% CI 90.2-91.1) and was similarly high in patients aged < 55 years (91.2%, 95% CI 89.7-92.4), 55 to < 60 (89.8%, 95% CI 88.8-90.7), 60 to < 65 (90.8%, 95% CI 90.1-91.6), 65 to < 70 (91.1%, 95% CI 90.1-91.9), 70 to < 75 (90.0%, 95% CI 86.9-92.4) and 75 years or older (93.8%, 95% CI 88.8-96.7). There were no major differences in unadjusted SVR rates 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 genotype/subgenotype, regimen, race/ethnicity, gender, HCV viral load, alcohol use disorder, cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and prior treatment experience.

DAAs are equally highly effective for the treatment of chronic HCV in all age groups including very elderly patients. Advanced age in and of itself should not be considered a barrier to DAA treatment.
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