Efficacy and safety of direct‐acting antivirals for hepatitis C in the elderly: A systematic review and meta‐analysis

Abstract

Background&Aims Since the introduction of direct‐acting antivirals (DAAs) several studies have reported high efficacy and safety in Hepatitis C infected patients, even in those earlier considered difficult‐to‐treat. We aimed to assess the efficacy and safety of DAA therapy in elderly patients. Methods The PubMed MEDLINE, Embase and Cochrane databases were searched through July 2018. Two independent researchers extracted data and assessed the quality and risk of bias. Risk ratios (RRs) were pooled using random effects models. The primary outcome was efficacy of DAA therapy assessed by the RR for non‐sustained virologic response (SVR) among patients aged <65 vs ≥65 years. Results Overall, we identified 63 studies including 34 082 patients treated with different DAAs. Risk for non‐SVR was comparable in patients <65 and ≥65 years of age (RR 1.00, 95% CI 0.86‐1.15; P = 0.979) and even lower in a subgroup analysis of cirrhotic patients ≥65 years of age (RR 0.59, 95% CI 0.35‐0.99, P = 0.044). Risk for non‐SVR was similar between age groups in all other subgroup analyses. Elderly patients had a significantly increased risk of adverse events (AEs) (RR 1.30, 95% CI 1.11‐1.52, P = 0.001), but not for serious adverse events (P = 0.43) or treatment discontinuation (P = 0.15). Risk for anaemia if treated with additional ribavirin was 2.84 (95% CI 1.73‐4.66, P < 0.001) in elderly patients compared to patients <65 years. Conclusion Our results show that DAAs are highly effective and safe in elderly patients. Ribavirin should be avoided in the elderly as more AEs and particularly anaemia is observed. Further cost‐effectiveness analyses are needed to evaluate the socio‐economic benefit of treating elderly people without advanced liver disease.

Impact of age on the characteristics and medical care of chronic hepatitis C patients treated with direct-acting antivirals

“…In previous studies, the age of 65 yo has been the most often selected as a threshold while 75 yo is a rarer choice [4] . In the meta-analysis of Mücke et al [5] , the DAA treatment was similarly effective in patients aged >65 yo when compared with the younger population. Subgroup analysis also revealed a comparable risk for non-SVR when evaluating studies assessing patients who were <75 yo vs >75 yo.…”

“…Before these drugs became available, the treatment was based on interferon, which had limited benefits for elderly patients due to its low safety profile and poor efficacy [3] . Many studies have reported the results of DAA treatment in elderly patients, the most recent in 2019 [4] , with a meta-analysis carried out in 2019 [5] . The studies were primarily focused on SVR 12 rates and incidence of undesirable effects, fixing the maximum age of inclusion at 65 or 75 years old (yo).…”

The risk of hepatitis C virus recurrence in hepatitis C virus‐infected patients treated with direct‐acting antivirals after achieving a sustained virological response: A comprehensive analysis

“…Consequently, SVR achieved with all‐oral DAAs is durable, and importantly, as durable as that obtained through IFN‐based therapy. Furthermore, due to the low risk of HCV recurrence even in the high‐risk HCV mono‐infection and HIV/HCV co‐infection populations, there would appear to be no reason to withhold or defer DAAs therapy in patients who remain at risk for reinfection 66‐70 …”

Hepatitis C Virus in the Elderly in the Direct-Acting Antiviral Era: from Diagnosis to Cure

“…Two meta-analyses reviewed clinical trials and post-marketing studies to evaluate the efficacy and safety of DAA regimens in the elderly population [34,35]. Overall, DAA therapies are highly effective and well-tolerated in patients ≥ 65 years old.…”