medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2019, Number 1

<< Back Next >>

Ann Hepatol 2019; 18 (1)

Effects of Age on Treatment of Chronic Hepatitis C with Direct Acting Antivirals

Pariente A, Arpurt Jean-Pierre, Rémy André-Jean, Rosa-Hézode I, Causse X, Heluwaert F, Macaigne G, Henrion J, Renou C, Schnee M, Salloum H, Hommel S, Pilette C, Arotcarena R, Barjonet G, Lison H, Bourhis F, Jouannaud V, Pauwels A, Le-Bricquir Y, Geagea E, Condat B, Ripault Marie-Pierre, Zanditenas D, de Montigny-Lenhardt S, Labadie H, Tissot B, Maringe E, Cadranel Jean-François, Hagège H, Lesgourgues B

Language: English
References: 29
Page: 193-202
PDF size: 382.41 Kb.


ABSTRACT

Introduction and aim. Data on the efficacy and tolerance of interferon-free treatment in chronic hepatitis C (CHC) in elderly patients are limited in phase II-III trials. Material and methods. A prospective cohort of adult patients with CHC treated in French general hospitals. Results. Data from 1,123 patients, distributed into four age groups, were analyzed. Of these, 278 were ≥ 64 years old (fourth quartile) and 133 were ≥ 73 years old (tenth decile). Elderly patients weighed less, were more frequently treatment-experienced women infected with genotype 1b or 2, while they less frequently had genotype 3 or HIV coinfection, but had more frequent comorbidities and drug consumption. Half of the patients had cirrhosis, whatever their ages. The main treatment regimens were sofosbuvir/ledipasvir (37.8%), sofosbuvir/daclatasvir (31.8%), sofosbuvir/simeprevir (16.9%), sofosbuvir/ribavirin (7.8%); ribavirin was given to 24% of patients. The overall sustained virological response (SVR) rate was 91.0 % (95% CI: 89.2- 92.5%) with no difference according to age. Logistic regression of the independent predictors of SVR were albumin, hepatocellular carcinoma and treatment regimen, but not age. The rate of severe adverse events (66 in 59/1062 [5.6%] patients) tended to be greater in patients older than 64 years of age (21/261, 8.1%), but the only independent predictors of SAE by logistic regression were cirrhosis and baseline hemoglobin. Patient-reported overall tolerance was excellent in all age groups, and patient-reported fatigue decreased during and after treatment, independent of age. Conclusions. The high efficacy and tolerance of interferonfree regimens is confirmed in elderly patients in real-life conditions.


REFERENCES

  1. Vespasiani-Gentilucci U, Galati G, Gallo P, de Vincentis A, Riva E, Picardi A. Hepatitis C treatment in the elderly : new possibilities and controversies towards interferon-free regimens. World J Gastroenterol 2015; 21: 7412-26.

  2. Yang Z, Zhuang L, Yang L, Liu C, Xu Q, Chen X, Chen L. Efficacy and safety of peginterferon plus ribavirin for patients aged ≥ 65 years with chronic hepatitis C: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2014; 38: 440-50.

  3. Thabut D, Le Calvez S, Thibault V, Massard J, Munteanu M, Di Martino V, Ratziu V, et al. Hepatitis C in 6865 patients 65 yr or older: a severe and negleted curable disease. Am J Gastroenterol 2006; 101:1260-7.

  4. Pariente A, Djilloul A, Cadranel JF, ANGH. Treatment of chronic hepatitis C with interferon alpha and ribavirin. Results in real life. Gastroenterol Clin Biol 2003; 27: 590-5.

  5. Pariente A, Lahmek P, Duprat C, Denis J, Faroux R, Renou C, Nalet B, et al. Treatment of chronic hepatitis C with pegylated interferon and ribavirin in treatment-naive patients in true life: a plea in favor of independent postmarketing evaluations. Eur J Gastroenterol Hepatol 2010; 22: 1297-302.

  6. Saab S, Park SH, Mizokami M, Omata M, Mangia A, Eggleton A, Zhu Y, et al. Safety and efficiency of ledipasvir/sofosbuvir for the treatment of genotype 1 hepatitis C in subjects aged 65 years or older. Hepatology 2016; 63: 1112-9

  7. Ogawa E, Furusyo N, Nomura H, Takahashi K, Higashi N, Kawano A, Dohmen K, et al. Effectiveness and safety of sofosbuvir plus ribavirin for HCV genotype 2 patients 65 and over with or without cirrhosis. Antivir Res 2016; 136: 37-44.

  8. Vermehren J, Peiffer K-H, Welsch G, Grammatikos G, Welker M-W, Weiler N, Zeuzem S, et al. The efficacy and safety of direct acting antiviral treatment and clinical significance of drug-drug interactions in elderly patients with chronic hepatitis C virus infection. Aliment Pharmacol Ther 2016; 44: 856-65.

  9. Su F, Beste LA, Green PK, Berry K, Ioannou GN. Direct-acting antivirals are effective for chronic hepatitis C in elderly patients : a real world study of 17 487 patients. Eur J Gastroenterol Hepatol 2017; 29: 686-93.

  10. Morio R, Imamura M, Kawakami Y, Morio K, Kobayashi T, Yokoyama S, Kimura Y, et al. Safety and efficacy of dual therapy with daclatasvir and sunaprevir for older patients with chronic hepayitis C. J Gastroenterol Hepatol 2017; 52: 504-11.

  11. Rodriguez-Osorio I, Cid P, Morano L, Castro A, Suarez M, Delgado M, Margusino L, et al. Real life experience with direct- acting antivirals agents against hepatitis C infection in elderly patients. J Clin Virology 2017; 88: 58-61.

  12. Sherigar JM, Gayam V, Khan A, Mukhtar O, Arefiev Y, Khalid M, Siddiqui I, et al. Clinical efficacy and tolerability of directacting antivirals in elderly patients with chronic hepatitis C. Eur J Gastroenterol Hepatol 2017; 29: 767-76.

  13. Pellicelli A, Pace Palitti V, Vignally P, Ceccherini-Silbertsein F, Siciliano M, Giannelli V, Moretti A, et al. Efficacy and safety of sofosbuvir/simeprevir plus flat dose ribavirin in genotype 1 elderly cirrhotic patients: a real-life study. Liver Intern 2017; 37: 653-61.

  14. Atsukawa M, Tsubota A, Kondo C, Shimada N, Abe H, Kato K, Okubo T, et al. Effectiveness and safety of communitybased treatment with sofosbuvir plus ribavirin for elderly patients with genotype 2 chronic hepatitis C. Dig Liver Dis 2017; 49: 1029-35.

  15. Akuta N, Sezaki H, Suzuki F, Kawamura Y, Hosaka T, Kobayashi M, Kobayashi M, et al. Favorable efficacy of daclatasvir plus asunaprevir in treatment of elderly japanese patients infected with HCV genotype 1b aged 70 and older. J Med Virol 2017; 89: 91-8.

  16. Conti F, Brillanti S, Buonfiglioli F, Vukotic R, Morelli MC, Lalanne C, Massari M, et al. Safety and efficacy of direct-acting antivirals for the treatment of chronic hepatitis C in real-world population aged 65 and older. J Viral Hep 2017; 24: 454-63.

  17. Ogawa E, Furusyo N, Yamashita N, Kawano A, Takahashi K, Dohmen K, Nakamuta M, et al. Effectiveness and safety of daclatasvir plus asunaprevir for patients with hepatitis C virus genotype 1b aged 75 years and over with or without cirrhosis. Hepatol Res 2017; 47: E120-31.

  18. Lens S, Fernandez I, Rodriguez-Tajes S, Hontangas V, Vegara M, Forné M, Calleja JL, et al. Interferon-free therapy in elderly patients with advanced liver disease. Am J Gastroenterol 2017; 112:1400-9.

  19. Patel A, Backstedt DW, Abidali H, Choi M, Pedersen M, Seetharam A. Effectiveness and tolerability of direct acting antiviral therapy for hepatitis C in a real world elderly cohorts. Clin Gastroenterol Hepatol 2017; 15: 603-4.

  20. Brouard C, Le Trat Y, Larsen C, Jauffret-Roustide M, Lot F, Pillonel J. The undiagnosed chronically-infected HCV population in France. Implications for expanded testing recommendations in 2014. PLoS ONE 2015: 10: e0126920.

  21. AASLD/IDSA HCV Guidance Panel. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology 2015; 62: 932-54.

  22. EASL Recommendations on treatment of hepatitis C 2016. J Hepatol 2017; 66: 153-94.

  23. AFEF. http://www.afef.asso.fr/RECOMMANDATIONS/recommandations_ 1

  24. Fontaine H, Petitprez K, Roudot-Thoraval F, Trinchet JC. Guidelines for the diagnosis of uncomplicated cirrhosis. Gastroenterol Clin Biol 2007; 31: 504-9.

  25. Common Terminology Criteria for Adverse events (CTCAE). V 4.03: june 14, 2010. https://ctep.cancer.gov/protocoldevelopment/ electronic_applications/ctc.htm.

  26. Vandenbroucke JP, Von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, Poole C, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Plos Med 2007; 4: e297.

  27. Calleja JL, Crespo J, Rincón D, Ruiz-Antorán, Fernandez I, Perelló C, Gea F, et al. Effectiveness, safety and clinical outcomes of direct-acting antiviral therapy in HCV genotype 1 infection/results from a Spanish real-world cohort. J Hepatol 2017; 66: 1138-48.

  28. Younossi Z, Stepanova M, Nader F, Henry L. Patients-reported outcomes of elderly adults with chronic hepatitis C treated with interferon- and ribavirin-free regimens. J Am Geriatr Soc 2016; 64: 386-93.

  29. Ciaccio A, Cortesi PA, Bellelli G, Rota M, Conti S, Okolicsanyi S, Rota M, et al. Direct-acting antivirals combination for elderly patients with chronic hepatitis C: a cost-effectiveness analysis. Liver Int 2017: 37: 982-4.




2020     |     www.medigraphic.com