Effects of Age on Treatment of Chronic Hepatitis C with Direct Acting Antivirals

Pariente, Alexandre; Arpurt, Jean‐Pierre; Remy, André‐Jean; Rosa-Hézode, I.; Causse, Xavier; Héluwaert, Frédéric; Macaigne, Gilles; Henrion, Jean; Renou, Christophe; Schnee, Matthieu; Salloum, Hatem; Hommel, Séverine; Pilette, Christophe; Arotçarena, Ramuntxo; Barjonet, Georges; Lison, Hortensia; Bourhis, Frangois; Jouannaud, Vincent; Pauwels, Arnaud; Le-Bricquir, Yann; Geagea, E; Condat, Bertrand; Ripault, Marie–Pierre; Zanditenas, David; Montigny-Lenhardt, S. de; Labadie, H; Tissot, Bertrand; Maringe, E.; Cadranel, Jean-Frangois; Hagège, Hervé; Lesgourgues, Bruno

doi:10.5604/01.3001.0012.7912

Cited by 5 publications

(4 citation statements)

References 25 publications

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“…Multiple prospective and retrospective real‐world studies assessed the treatment efficacy of DAAs in the older age group in different countries . Most of these studies are limited by a small sample, except two studies by Su et al 26 and Lens et al 35 In the retrospective analysis from the Veteran Affairs (VA) healthcare system by Su et al, DAA regimens reported high overall SVR12 rates of 91% to 93.8% in different age subgroups of patients older than 65 years.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Direct‐Acting Antivirals for Chronic Hepatitis C in a Large Cohort of Older Adults in the United States

Pan

Gayam

Rabinovich³

et al. 2019

J American Geriatrics Society

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OBJECTIVES: Data on the virologic response and tolerability of direct-acting antivirals (DAAs) are lacking in older people because these individuals are underrepresented in clinical trials. This study aimed to assess the effectiveness and tolerability of DAA regimens in older individuals in a large cohort of real-life clinical practice. METHODS: In this retrospective study, patients with chronic hepatitis C infection between 2017 and 2018 were divided into patients aged 65 years and older and those younger than 65 years. We evaluated the sustained virologic response rates (SVRs) in both groups. Further subgroup analyses on the SVRs for patients aged 65 to 74, 75 to 84, and 85 years and older were performed. We also analyzed the predictors of treatment response in older individuals. RESULTS: Among 1151 eligible patients, 516 were in the older group and 635 were in the younger group. The overall treatment response in the entire cohort was 97.7%. A significantly higher percentage of patients presented with advanced stages of fibrosis in the older group (53.1% vs 39.5%; P = <.001). The SVR rates were similar between the two groups (98.3% vs 97.7%; P = .18). In multivariate models, age was not predictive of SVR after adjusting for confounders. Subgroup analyses in the age groups of 65 to 74, 75 to 84, and older than 85 years showed similar treatment response rates (97.4%, 97.2%, and 86.7, respectively; P = .06) and advanced fibrosis (50.8%, 61.5%, and 53.3%, respectively; P = .14). CONCLUSION: Although older people exhibit a significantly higher frequency of fibrosis, DAAs produce high rates of SVR in all age groups, and the age of the patient does not seem to have a significant impact on the efficacy of DAAs including patients in the oldest age category (≥75 y). Treatment should not be withheld in older individuals. J Am Geriatr Soc 68:379-387, 2020.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Direct‐Acting Antivirals for Chronic Hepatitis C in a Large Cohort of Older Adults in the United States

Pan

Gayam

Rabinovich³

et al. 2019

J American Geriatrics Society

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“…Neste grupo de pacientes, a administração de IFN levava a eventos adversos severos e a uma baixa taxa de eliminação viral 19 . Vale registrar que diversos estudos apontam que não há diferença nas taxas de RVS com uso de AAD em pacientes com idade mais avançada, segundo Pariente et al 29 . Nesse estudo francês, com pacientes portadores de hepatite C crônica em uso de AAD, alcançou-se uma RVS de 91% em uma população com idade média de 56 anos.…”

Section: Discussionunclassified

“…Nesse estudo francês, com pacientes portadores de hepatite C crônica em uso de AAD, alcançou-se uma RVS de 91% em uma população com idade média de 56 anos. Na análise de subgrupos, pacientes com 51-56 anos e com idade superior a 64 anos obtiveram as maiores taxas de RVS 29 . Outro estudo, de Elbaz et al 30 , que incluiu pacientes com idade média de 65,9 anos, demonstrou uma taxa de RVS de 91,9% com o uso da combinação sofosbuvir + daclatasvir associada ou não à ribavirina 30 .…”

Section: Discussionunclassified

“…Contudo, vale lembrar que uma das limitações nesse cenário reside no fato de a maior parte dos estudos de fases II e III excluir pacientes com idade superior a 70-75 anos e com comorbidades severas associadas. Outra constatação importante do estudo francês foi de que a idade por si só não deve ser considerada uma contraindicação ao tratamento com AAD, porém a presença de comorbidades associadas deve ser avaliada, em virtude de uma maior chance de interações medicamentosas negativas e maior desenvolvimento de efeitos adversos 29,31 . Além disso, Keast et al 31 evidenciaram que pacientes com hepatite C crônica tiveram maior falha terapêutica quando utilizavam medicações concomitantes aos AAD (HR 3.218, 95% CI 1.584-6.530, p=0,001).…”

Section: Discussionunclassified

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Risco de Recorrência do Carcinoma Hepatocelular após o Uso de Antivirais de Ação Direta no Tratamento de Hepatite C: Revisão Sistemática e Metanálise

Cuba¹,

Anjos²,

Toderke³

et al. 2021

Rev. Bras. Cancerol.

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Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I2=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto a terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.

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Efficacy and safety of direct‐acting antiviral therapy for hepatitis C virus in elderly patients (≥65 years old): A systematic review and meta‐analysis

Lee

Ahn

Yim

et al. 2022

Journal of Viral Hepatitis

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Direct‐acting agents (DAAs) have launched a new era of hepatitis C virus (HCV) treatment. As aged individuals comprise a large percentage of HCV‐infected patients, the effectiveness and safety of DAAs in the elderly have come under scrutiny. This meta‐analysis aimed to evaluate the efficacy and safety of DAAs in elderly patients. After a systematic search in PubMed (MEDLINE), Embase, OVID MEDLINE, the Cochrane Library and other databases, two investigators reviewed relevant abstracts and selected manuscripts for examination. The sustained virologic response (SVR) and adverse event (AE) rates were calculated with a random‐effects model. Ninety studies evaluating SVR rates of elderly patients (≥65 years old) receiving DAAs were selected. DAAs in elderly patients exhibited a notable SVR rate of 96% (95% confidence interval [CI]: 95%–97%), accompanied by comparable rates in subgroup analyses. The comparison of SVR rates in elderly and non‐elderly patients indicated no significant discrepancy (odds ratio [OR] 1.01, 95% CI: 1.00–1.01). The overall event rate of AEs was 45% (95% CI: 31%–60%), though AE rates varied by subgroups. Furthermore, AEs were comparatively more frequent (OR 1.15, 95% CI: 1.04–1.28) in the elderly than non‐elderly, especially in subgroups such as SAE (OR 1.89, 95% CI: 1.52–2.36) and dose reduction in ribavirin (OR 1.90, 95% CI: 1.53–2.36). However, in the ribavirin (RBV)‐free regimen, there was no significant difference in the incidence of AEs between the elderly and non‐elderly groups. DAAs have high efficacy in elderly patients. Considering the possibility of AE, the RBV‐free regimen should be given prior consideration for the treatment of elderly patients with HCV.

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Effects of Age on Treatment of Chronic Hepatitis C with Direct Acting Antivirals

Cited by 5 publications

References 25 publications

Efficacy of Direct‐Acting Antivirals for Chronic Hepatitis C in a Large Cohort of Older Adults in the United States

Efficacy of Direct‐Acting Antivirals for Chronic Hepatitis C in a Large Cohort of Older Adults in the United States

Risco de Recorrência do Carcinoma Hepatocelular após o Uso de Antivirais de Ação Direta no Tratamento de Hepatite C: Revisão Sistemática e Metanálise

Efficacy and safety of direct‐acting antiviral therapy for hepatitis C virus in elderly patients (≥65 years old): A systematic review and meta‐analysis

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