Hepatitis C direct-acting antiviral outcomes in patients 75 years and older

Abstract

Background and aim: Elderly patients with hepatitis C virus (HCV) infection have worse interferon-based treatment outcomes than young patients. Direct-acting antiviral (DAA) regimens have enabled the treatment of previously difficult-to-cure populations. There are few studies that specifically assess DAA treatment outcomes in patients over 75 years of age.

Methods: Design: This was a cohort study. Setting: The setting was three Canadian HCV specialty sites. Participants: Patients aged 75 years and older and treated with DAA without interferon were enrolled. Measurements: Patient demographics, liver fibrosis by transient elastography, treatment regimen, and treatment outcome data were collected.

Results: The mean age of 78 patients in our analysis was 78.6 years (SD 3.5; range: 75-88 years). The most common genotype was 1b (35%). The most frequently utilized regimens included sofosbuvir-velpatasvir (33%) and ledipasvir-sofosbuvir (32%). Ribavirin was included for 17% of recipients. Sustained virological response (SVR) was achieved in 94% of patients (69% of those receiving ribavirin and 98% of patients on ribavirin-free regimens). Ribavirin toxicity contributed to the lower SVR rates in ribavirin-exposed patients. Ribavirin dosage was decreased in three patients and ultimately discontinued in two of these patients. All treatment was discontinued in another two patients.

Conclusion: Ribavirin-free DAA therapy is safe and achieves SVR rates in older adults comparable to those described in the general population. RBV inclusion frequently results in complications, often leads to treatment modification or interruption, and does not improve SVR rates in those with advanced age.

Keywords: direct‐acting antivirals; elderly; hepatitis C; ribavirin; sustained virologic response.