Hepatitis C - Interferon-free therapy in elderly patients with advanced liver disease

Interferon-free therapy in elderly patients with advanced liver disease
The most recent issue of the American Journal of Gastroenterology assessed the effectiveness and tolerability of all-oral regimens in elderly patients in real-life clinical practice.

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.

Dr Sabela Lens and colleagues assessed the effectiveness and tolerability of all-oral regimens in elderly patients in real-life clinical practice.

The team performed a retrospective analysis of hepatitis C virus (HCV) patients aged ≥65 years receiving interferon-free regimens within the Spanish National Registry (Hepa-C).

The researchers recorded data of 1,252 patients.

Of these, 76% were aged 65–74 years, 17% were aged 75–79 years, and 7% were aged ≥80 years at the start of antiviral therapy.

The team found that 86% had HCV genotype-1b, and 48% were previous non-responders. The rate of severe adverse events increased with age category
American Journal of Gastroenterology

A significant proportion of patients had cirrhosis, of whom 11% presented decompensated liver disease.

The researchers found that most used regimens were SOF/LDV, 3D, and SOF/SMV.

The team noted that ribavirin was added in 49% of patients.

Overall, the sustained virological response rate was 94% without differences among the 3 age categories.

Albumin 3.5 g/dl or less was the only independent negative predictor of response.

Regarding tolerability, the rate of severe adverse events increased with age category.

In addition, the team noted that the main predictors of mortality were age 75 years or more, and albumin 3.5 or less.

Dr Lens' team conclude, "Sustained virological resposne rates with interferon-free regimens in elderly patients are high and comparable to the general population."

"Baseline low albumin levels was the only predictor of treatment failure."

"Importantly, the rate of severe adverse events and death increased with age."

"Elderly patients or those with advanced liver disease presented higher mortality."

"Thus a careful selection of patients for antiviral treatment is recommended."

Source - https://www.gastrohep.com/news/news.asp?id=112812
Am J Gastroenterol 2017; 112:1400–1409
02 October 2017