Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep;112(9):1400-1409.
doi: 10.1038/ajg.2017.157. Epub 2017 Jun 6.

Interferon-Free Therapy in Elderly Patients With Advanced Liver Disease

Sabela Lens  1 , Inmaculada Fernández  2 , Sergio Rodríguez-Tajes  1 , Vanessa Hontangas  3 , Mercedes Vergara  4 , Montserrat Forné  5 , Jose Luis Calleja  6 , Moisés Diago  7 , Jordi Llaneras  8 , Susana Llerena  9   10 , Xavier Torras  11 , Begoña Sacristán  12 , Merce Roget  13 , Conrado Manuel Fernández-Rodríguez  14 , Mari Carmen Navascués  15 , Javier Fuentes  16 , Juan-José Sánchez-Ruano  17 , Miguel-Ángel Simón  18 , Federico Sáez-Royuela  19 , Carmen Baliellas  20 , Rosa Morillas  21 , Xavier Forns  1 ; Spanish Group for the Study of the Use of Direct-acting Drugs Hepatitis C Collaborating Group
Collaborators, Affiliations

Interferon-Free Therapy in Elderly Patients With Advanced Liver Disease

Sabela Lens et al. Am J Gastroenterol. 2017 Sep.

Abstract

Objectives: Interferon-free therapies have an improved safety and efficacy profile. However, data in elderly patients, who have frequently advanced liver disease, associated comorbidities, and use concomitant medications are scarce. The im of this study was to assess the effectiveness and tolerability of all-oral regimens in elderly patients in real-life clinical practice.

Methods: Retrospective analysis of hepatitis C virus (HCV) patients aged ≥65 years receiving interferon-free regimens within the Spanish National Registry (Hepa-C).

Results: Data of 1,252 patients were recorded. Of these, 955 (76%) were aged 65-74 years, 211 (17%) were aged 75-79 years, and 86 (7%) were aged ≥80 years at the start of antiviral therapy. HCV genotype-1b was predominant (88%) and 48% were previous non-responders. A significant proportion of patients had cirrhosis (922; 74%), of whom 11% presented decompensated liver disease. The most used regimens were SOF/LDV (33%), 3D (28%), and SOF/SMV (26%). Ribavirin was added in 49% of patients. Overall, the sustained virological response (SVR12) rate was 94% without differences among the three age categories. Albumin ≤3.5 g/dl was the only independent negative predictor of response (0.25 (0.15-0.41); P<0.01). Regarding tolerability, the rate of severe adverse events increased with age category (8.8, 13, and 14%; P=0.04). In addition, the main predictors of mortality (2.3%) were age ≥75 years (2.59 (1.16-5.83); P =0.02) and albumin ≤3.5 (17 (6.3-47); P <0.01).

Conclusions: SVR rates with interferon-free regimens in elderly patients are high and comparable to the general population. Baseline low albumin levels (≤3.5 g/dl) was the only predictor of treatment failure. Importantly, the rate of severe adverse events and death increased with age. Elderly patients (≥75 years) or those with advanced liver disease (albumin ≤3.5) presented higher mortality. Thus a careful selection of patients for antiviral treatment is recommended.

PubMed Disclaimer

References

    1. N Engl J Med. 2014 Apr 17;370(16):1483-93 - PubMed
    1. Adv Ther. 2015 Jul;32(7):637-49 - PubMed
    1. J Am Geriatr Soc. 2016 Feb;64(2):386-93 - PubMed
    1. Aliment Pharmacol Ther. 2016 Oct;44(8):856-65 - PubMed
    1. J Hepatol. 2017 Jan;66(1):153-194 - PubMed

MeSH terms

LinkOut - more resources