Treatment with direct-acting antivirals (DAAs) is safe and effective in elderly people
with hepatitis C virus (HCV) infection, according to German research published in Drugs & Aging. Elderly people
(aged 70 years and older) were as likely as non-elderly people to be cured
(93% vs 91%). Incidence of serious adverse events was somewhat higher in
elderly people, though the rate was low.
“The SVR [sustained virological response] rates in
this real-life cohort was generally high, and they showed no differences
between age groups. Accordingly, age was not associated with SVR in the
logistic regression analysis,” comment the authors. “In general, the safety
profile of DAA treatment regimens in elderly patients is favorable."
The patients were
enrolled in the German Hepatitis C Registry (DHC-R), a prospective, multi-centre,
real-world cohort study. The investigators noted that even though the
HCV-infected population is ageing, very little is known about the demographics
of over-70s with HCV and the safety and effectiveness of all-DAA regimens in
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“The aging of the
HCV-infected population and availability of highly effective and tolerable
treatment regimens have led to an increase in the number of elderly patients
being eligible for DAA therapy,” observe the authors. “Still, our understanding
of this elderly cohort of HCV-infected patients regarding epidemiological
features, treatment success and safety is limited as the vast majority of data
on DAA treatment is limited to populations younger than 70 years of age.”
according to age (elderly vs non-elderly), the investigators examined the
demographic characteristics of people who started all-oral DAA regimens after
September 2014. Treatment outcomes and safety were compared between the elderly
and non-elderly groups.
population consisted of 7133 people, 10% of whom were aged 70 years and
older. Most of the participants were white.
There were some
significant demographic and clinical differences between the elderly and
non-elderly patient groups. A higher proportion of elderly people were female
(65% vs 39%). Liver-related complications, including cirrhosis, hepatocellular
carcinoma and liver transplant were more common among elderly individuals (44%
vs 27%; 2.5% vs 1.2%; 2.5% vs1.9%, respectively). Several diseases
associated with older age were also more prevalent in elderly people,
including cardiovascular disease, type 2 diabetes and renal impairment (59% vs
23%; 17% vs 8%; 79% vs 27%, respectively). In contrast, non-elderly patients
had a higher prevalence of psychiatric disorders, drug and alcohol abuse and
Mode of HCV
transmission also differed by age. Blood products and surgical or medical
procedures were the most common mode of transmission among elderly people. In
younger people, the drug use and sexual transmission were the most frequent
modes of transmission.
treatment response rate was 91% and was similar between elderly and non-elderly
people (93% vs 91%). Baseline and clinical characteristics possibly
associated with treatment response were investigated in univariate and
multivariate analysis. Age was not associated with SVR12 in either analysis.
In terms of
safety, similar proportions of elderly and non-elderly people reported one or
more adverse event (53% vs 55%).
The incidence of
serious adverse events, although low, was higher among elderly people than
non-elderly individuals (8% vs 4%). Similarly, incidence of serious
liver-related adverse events was higher in the over 70s than younger people
(2% vs 1%). This finding was almost entirely attributable to the higher
incidence of hepatocellular carcinoma in elderly people (0.9% vs 0.2%).
The rate of
treatment discontinuation was low in both the elderly and non-elderly groups
(0.7% vs 0.2%). As expected, the mortality rate was higher among the over 70s
(0.4% vs 0.1%).
containing regimens were taken by approximately a third of people in each age
group. Elderly people were more likely than non-elderly people to have a
ribavirin dose reduction (25% vs 12%), but the rate of ribavirin
discontinuations was similar, regardless of age (1.5% vs 1.4%).
results demonstrate that DAA treatment regimens are effective and safe in
elderly HCV-infected patients,” conclude the authors. “An absolute age limit
for HCV treatment does not exist. Accordingly, as the infection is frequently
unrecognized, hepatologists, geriatric physicians and general practitioners
should be encouraged to screen for HCV in elderly patients whenever elevated
liver enzymes are detected or chronic liver disease is suspected.”