Clinical efficacy and tolerability of direct-acting antivirals in elderly patients with chronic hepatitis C. Issue 7 (July 2017)

• Record Type: Journal Article
• Authors: Sherigar, Jagannath M.; Gayam, Vijay; Khan, Arifa; Mukhtar, Osama; Arefiev, Yavgeniy; Khalid, Mazin; Siddiqui, Imran; Rangaraju, Ayyappa M.; Budhathoki, Nibash; Mansour, Mohammed; Guss, Debra; Mohanty, Smruti R.
• Is Part Of: European journal of gastroenterology & hepatology. Volume 29:Issue 7(2017:Jul.)
• Publication Date: 2017-07
• Subjects: adverse drug reactions -- chronic hepatitis C -- direct-acting antiviral agents -- elderly patients -- interferon -- ribavirin -- sustained virologic response; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Digestive organs -- Diseases; Liver -- Diseases; Periodicals; 616.33
• DOI: 10.1097/MEG.0000000000000871
• Languages: English
• ISSNs: 0954-691X

Abstract

Abstract : Background: There is a lack of evidence-based data on aged patients with newer direct-acting antivirals (DAAs) and with shorter duration of treatment regimens involving DAAs with or without ribavirin (RBV) and pegylated interferon (Peg IFN). Patients and methods: Medical records of 240 patients treated with DAAs with or without Peg IFN and RBV between January 2013 and July 2015 were retrospectively analyzed. Patients were divided into two groups: patients aged 65 years and older ( N =84) and patients aged younger than 65 years ( N =156). Pretreatment baseline patient characteristics, treatment efficacy, factors affecting sustained virologic response at 12 weeks after treatment, and adverse reactions were compared between the groups. Results: No statistically significant difference was observed with end of treatment response (98.8 vs. 98%, P =0.667) and sustained virologic response at 12 weeks after treatment (93.1 vs. 94.1%, P =0.767) between patients aged 65 and older and those younger than 65 years of age. Fatigue was the most common adverse event recorded (32.5%), followed by anemia (19.6%), leukopenia (11.7%), thrombocytopenia (10%), skin rash (8.3%), and headache (7.9%). The RBV dose was reduced in eight (8%) patients and four patients discontinued the RBV treatment because of severe anemia. RBV dose reduction or discontinuation did not reach statistical significance ( P =0.913). Increased fibrosis, cirrhosis, aspartate aminotransferase, alanine aminotransferase, hemoglobin, and platelet levels seem to affect the sustained virologic response in the elderly. Twelve (6.28%) patients failed to respond to treatment and the failure rate was not significant ( P =0.767) between the groups. Conclusion: DAAs with or without IFN and RBV in the standard recommended 12 or 24-week treatment regimens are effective, well tolerated, and may be safely extended to elderly patients infected with chronic hepatitis C.