DAAs safe and effective in elderly people with HCV

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 elderly people.

“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.”

Stratifying 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.

The study 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 viral co-infections.

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.

The overall 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%).

Ribavirin 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%).

“The reported 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.”