In the Journals

DAA therapy effective, well-tolerated in elderly patients

Direct-acting antiviral therapy for hepatitis C was highly effective and well-tolerated in patients aged 65 years and older, resulting in most patients achieving sustained virologic response, according to results of a recent study.

“Hospital admission rates are steadily increasing in the elderly HCV viremic population, with higher inpatient charges, longer hospital stays, and more moderate/severe illness,” Amitkumar Patel, MD, from the Transplant and Advanced Liver Disease Center, University of Arizona College of Medicine, and colleagues wrote. “However, receipt of curative treatment is associated with reduction in hepatocellular cancer and overall mortality, irrespective of age.”

The researchers enrolled 88 patients undergoing DAA treatment between Nov. 1, 2014, and Jan. 28, 2016. Mean patient age was 68.7 years (range, 65-86 years), 59.6% were men and 35.5% had cirrhosis. Patients were either treatment-naive (n = 31), relapsed (n = 27) or were non-responders to initial treatment (n = 3).

Genotypes present in the cohort included 1a (n = 32), 1b (n = 27), 2 (n = 13), 3 (n = 12), 4 (n = 2) and 6 (n = 2). Thirty-one patients were treated with Sovaldi (sofosbuvir, Gilead) plus ribavirin, 35 were treated with Harvoni (sofosbuvir/ledipasvir, Gilead), 11 were treated with Harvoni plus ribavirin, and 11 were treated with Olysio (simeprevir, Janssen) plus sofosbuvir.

All patients achieved end of treatment response and 81 achieved SVR at 12 weeks. The researchers saw significant reductions from the beginning of treatment to virologic response at 12 weeks in alanine aminotransferase (65.3 IU/mL vs. 24.6 IU/mL; P < .001) and significant increases in albumin (3.58 g/dL vs. 3.92 g/dL; P < .001) and platelet count (150,000 vs. 161,000; P = .007).

“DAA therapy in the elderly is highly effective and tolerable. [SVR] was uncompromised by RBV dose reduction in our sample of patients,” the researchers wrote. “We observed significant improvements in surrogates for inflammation, portal hypertension, and synthetic function with [SVR] assessment. Further longitudinal studies are warranted to evaluate impact of DAA regimens on disease-specific and all-cause-related health care expenditure in the geriatric population.” – by Talitha Bennett

Disclosures: Patel reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.