Efficacy and tolerability of an IFN-free regimen with DCV/ASV for elderly patients infected with HCV genotype 1B

Hidenori Toyoda, Takashi Kumada, Toshifumi Tada, Noritomo Shimada, Koichi Takaguchi, Tomonori Senoh, Kunihiko Tsuji, Yoshihiko Tachi, Atsushi Hiraoka, Toru Ishikawa, Toshihide Shima, Takeshi Okanoue

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Abstract

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.

Original languageEnglish
Pages (from-to)521-527
Number of pages7
JournalJournal of Hepatology
Volume66
Issue number3
DOIs
Publication statusPublished - 01-03-2017
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Hepatology

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    Toyoda, H., Kumada, T., Tada, T., Shimada, N., Takaguchi, K., Senoh, T., Tsuji, K., Tachi, Y., Hiraoka, A., Ishikawa, T., Shima, T., & Okanoue, T. (2017). Efficacy and tolerability of an IFN-free regimen with DCV/ASV for elderly patients infected with HCV genotype 1B. Journal of Hepatology, 66(3), 521-527. https://doi.org/10.1016/j.jhep.2016.11.012