Safety and efficacy of directly‐acting antiviral therapy for chronic hepatitis C virus in elderly people

• Published in: Aging medicine 2021-12, Vol.4 (4), p.304-316
• Main Authors: De Santis, Adriano, Maggi, Daniela, Lubrano Lobianco, Federica
• Format: Article
• Language: English
• Subjects: Age; Blood transfusions; Body mass index; DAAs; Datasets; Drug interactions; efficacy; elderly; HCV; Hepatitis B; Hepatitis C; Illnesses; Infections; Interferon; Liver cirrhosis; Liver diseases; Older people; Original; Patients; Population; REGULAR ARTICLES; safety; Ultrasonic imaging
• ISSN: 2475-0360; 2475-0360
• DOI: 10.1002/agm2.12190

Introduction In Italy, the prevalence of hepatitis C virus (HCV) infection is higher in the elderly, although the efficacy and safety of treatment in this population has not been extensively studied. Moreover, little is known about how much pharmacological interaction affects eligibility to treatment and to what extent the treatment affects subsequent outcomes. Methods We retrospectively analyzed the efficacy and safety of directly acting antivirals (DAAs), drug‐to‐drug interactions, and post‐treatment outcomes in 138 patients with HCV aged 70 years or older, who were consecutively treated in our center between 2015 and 2020. Results The mean age was 77 years old (range = 70–95 years old). The Cumulative Illness Rating Scale of pretherapy severity was classified as moderate to severe in 65% of patients. Fifty‐five patients (40%) presented compensated cirrhosis, eight of which were complicated by hepatocellular carcinoma (HCC) and all were cured before treatment. One hundred two patients (74%) were taking two or more drugs (range = 0–5 concomitant drugs registered) and in 29 patients (21%) we found potential drug‐to‐drug interaction. In 11 of those 29 patients (38%), we were forced to change the chronic therapy, when all therapeutic regimens were equal in terms of efficacy and interactions, to avoid potentially serious drug interactions. One serious adverse event occurred in our sample population (i.e., diverticular bleeding due to interaction with direct oral anticoagulants [DOACs]), whereas mild side effects occurred in 37% of patients. The undetectability of HCV RNA at the end of treatment was achieved in 97% of patients, whereas a sustained virological response (SVR) 12 and SVR 24 were obtained in 98% of patients. When comparing pretherapy with post‐therapy data, after a medium follow‐up of 15 months (median = 1 year, minimum = 2 months, and maximum = 4 years), we observed a reduction in the incidence of episodes of liver decompensation in patients with cirrhosis and a slight increase in the incidence of HCC (with 6 recurrent and 5 de novo HCC), diagnosed within 13 months from the end of therapy. In all patients, we found a significant improvement in all ultrasound variables and a significant reduction in the elastographic measurements. No significant differences in outcomes were observed dividing the population into patients aged ≥ 80 and