Background & Aims Anti-hepatitis C virus (HCV) therapy by interferon (IFN)-free regimen with oral direct-acting antiviral drugs are tolerable in aged patients, with fewer adverse effects than IFN-based therapies. We investigated the efficacy and tolerability of an IFN-free anti-HCV therapy in extremely aged patients, as well as the survival benefit of sustained virologic response (SVR). Methods Following IFN-free therapy with daclatasvir and asunaprevir, tolerability and SVR rate were compared between 115 HCV genotype 1-infected patients aged 80 years or older, 151 patients in their 70s (⩾70 and <80 years), and 115 patients under the age of 70. One-year mortality and morbidity in patients aged ⩾80 years were compared between SVR patients and propensity score-matched patients with persistent HCV infection. Results The SVR rate was 96.5% in patients ⩾80 years, comparable to that in patients aged ⩾70 and <80 years (95.4%) and patients aged <70 years (93.9%). There were no differences in treatment discontinuation rate (2.6%, 1.3%, and 0.9%, respectively). One-year mortality was significantly lower in SVR patients (2.7%) than in patients with persistent HCV infection (15.3%, p = 0.0016). Whereas 1-year mortality due to liver-related diseases was 8.1% in patients with persistent HCV infection who were aged ⩾80 years, no SVR patients died from liver diseases within 1-year after the end of therapy. Conclusions IFN-free therapy for HCV infection was associated with high tolerability and antiviral efficacy, even in patients aged ⩾80 years. In addition, there seemed to be a survival benefit from the eradication of HCV in this population. Lay summary IFN-free therapy with oral direct-acting antiviral drugs (daclatasvir and asunaprevir) for HCV infection showed similar tolerability and antiviral efficacy in patients aged ⩾80 years as in younger patients (patients aged ⩾70 and <80 years and patients aged <70 years), with an SVR rate over 90% and no severe adverse effects. There was a survival benefit from the eradication of HCV even in patients aged ⩾80 years.
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