Hidenori Toyoda1, Takashi Kumada2, Toshifumi Tada2, Noritomo Shimada3, Koichi Takaguchi4, Tomonori Senoh4, Kunihiko Tsuji5, Yoshihiko Tachi6, Atsushi Hiraoka7, Toru Ishikawa8, Toshihide Shima9, Takeshi Okanoue9. 1. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. Electronic address: hmtoyoda@spice.ocn.ne.jp. 2. Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. 3. Department of Gastroenterology, Otakano-mori Hospital, Kashiwa, Japan. 4. Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan. 5. Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan. 6. Department of Gastroenterology and Hepatology, Komaki City Hospital, Komaki, Japan. 7. Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Japan. 8. Department of Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan. 9. Department of Gastroenterology, Saiseikai Suita Hospital, Osaka, Japan.
Abstract
BACKGROUND & AIMS: Anti-hepatitis C virus (HCV) therapy by interferon (IFN)-free regimen with oral direct-acting antiviral drugs are tolerable in aged patients, with fewer adverse effects than IFN-based therapies. We investigated the efficacy and tolerability of an IFN-free anti-HCV therapy in extremely aged patients, as well as the survival benefit of sustained virologic response (SVR). METHODS: Following IFN-free therapy with daclatasvir and asunaprevir, tolerability and SVR rate were compared between 115 HCV genotype 1-infected patients aged 80years or older, 151 patients in their 70s (⩾70 and <80years), and 115 patients under the age of 70. One-year mortality and morbidity in patients aged ⩾80years were compared between SVR patients and propensity score-matched patients with persistent HCV infection. RESULTS: The SVR rate was 96.5% in patients ⩾80years, comparable to that in patients aged ⩾70 and <80years (95.4%) and patients aged <70years (93.9%). There were no differences in treatment discontinuation rate (2.6%, 1.3%, and 0.9%, respectively). One-year mortality was significantly lower in SVR patients (2.7%) than in patients with persistent HCV infection (15.3%, p=0.0016). Whereas 1-year mortality due to liver-related diseases was 8.1% in patients with persistent HCV infection who were aged ⩾80years, no SVR patients died from liver diseases within 1-year after the end of therapy. CONCLUSIONS: IFN-free therapy for HCV infection was associated with high tolerability and antiviral efficacy, even in patients aged ⩾80years. In addition, there seemed to be a survival benefit from the eradication of HCV in this population. LAY SUMMARY: IFN-free therapy with oral direct-acting antiviral drugs (daclatasvir and asunaprevir) for HCV infection showed similar tolerability and antiviral efficacy in patients aged ⩾80years as in younger patients (patients aged ⩾70 and <80years and patients aged <70years), with an SVR rate over 90% and no severe adverse effects. There was a survival benefit from the eradication of HCV even in patients aged ⩾80years.
BACKGROUND & AIMS: Anti-hepatitis C virus (HCV) therapy by interferon (IFN)-free regimen with oral direct-acting antiviral drugs are tolerable in aged patients, with fewer adverse effects than IFN-based therapies. We investigated the efficacy and tolerability of an IFN-free anti-HCV therapy in extremely aged patients, as well as the survival benefit of sustained virologic response (SVR). METHODS: Following IFN-free therapy with daclatasvir and asunaprevir, tolerability and SVR rate were compared between 115 HCV genotype 1-infectedpatients aged 80years or older, 151 patients in their 70s (⩾70 and <80years), and 115 patients under the age of 70. One-year mortality and morbidity in patients aged ⩾80years were compared between SVR patients and propensity score-matched patients with persistent HCV infection. RESULTS: The SVR rate was 96.5% in patients ⩾80years, comparable to that in patients aged ⩾70 and <80years (95.4%) and patients aged <70years (93.9%). There were no differences in treatment discontinuation rate (2.6%, 1.3%, and 0.9%, respectively). One-year mortality was significantly lower in SVR patients (2.7%) than in patients with persistent HCV infection (15.3%, p=0.0016). Whereas 1-year mortality due to liver-related diseases was 8.1% in patients with persistent HCV infection who were aged ⩾80years, no SVR patients died from liver diseases within 1-year after the end of therapy. CONCLUSIONS:IFN-free therapy for HCV infection was associated with high tolerability and antiviral efficacy, even in patients aged ⩾80years. In addition, there seemed to be a survival benefit from the eradication of HCV in this population. LAY SUMMARY:IFN-free therapy with oral direct-acting antiviral drugs (daclatasvir and asunaprevir) for HCV infection showed similar tolerability and antiviral efficacy in patients aged ⩾80years as in younger patients (patients aged ⩾70 and <80years and patients aged <70years), with an SVR rate over 90% and no severe adverse effects. There was a survival benefit from the eradication of HCV even in patients aged ⩾80years.
Authors: Georg Dultz; Tobias Müller; Jörg Petersen; Stefan Mauss; Tim Zimmermann; Marion Muche; Karl-Georg Simon; Thomas Berg; Stefan Zeuzem; Dietrich Hüppe; Klaus Böker; Heiner Wedemeyer; Tania M Welzel Journal: Drugs Aging Date: 2018-09 Impact factor: 4.271