Brooklyn, NY—When interferon-based regimens were the primary treatment for chronic hepatitis C, older patients generally were considered to be both poor responders and difficult to treat. That cohort had difficulty tolerating the therapy and, as a result, had higher discontinuation rates, inadequate response, and more adverse effects.

That has changed, however, with the introduction of regimens of interferon-free direct-acting antivirals (DAAs), according to an article in the Journal of the American Geriatric Society. International researchers, including participants from Interfaith Medical Center at SUNY Downstate University Hospital in Brooklyn, New York, report that rates of sustained virologic response (SVR) have improved markedly, with overall cure rates of more than 90% in clinical trials and in real-life settings. 

Yet their study notes that data on the virologic response and tolerability of direct-acting antivirals (DAAs) are lacking in older patients, who are underrepresented in clinical trials. In response, the study team sought to assess the effectiveness and tolerability of DAA regimens in older individuals in a large cohort of real-life clinical practice.

For the retrospective study, researchers divided patients with chronic hepatitis C infection between 2017 and 2018 into two groups—those aged 65 years and older and those younger than age 65 years—to evaluate sustained virologic response rates (SVRs) in both groups. In addition, subgroup analyses on the SVRs for patients aged 65 to 74 years, 75 to 84 years, and 85 years and older were performed and the predictors of treatment responses in older patients were analyzed.

Among 1,151 eligible participants, 516 were in the older group and 635 were in the younger group. The older group included a significantly higher percentage of patients with advanced stages of fibrosis (53.1% vs. 39.5%; P = <.001). 

Results indicate that the overall treatment response in the entire cohort was 97.7%, with SVR rates similar between the two groups (98.3% vs. 97.7%; P =.18). In fact, the study team reports that, in multivariate models, age was not predictive of SVR after adjusting for confounders. 

Furthermore, subgroup analyses in the age groups of 65 to 74 years, 75 to 84 years, 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).

“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),” the authors conclude. “Treatment should not be withheld in older individuals.”

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