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DAA therapy benefits elderly with HCV genotype 1b similarly to younger patients

Direct-acting antiviral therapy with daclatasvir, known as Daklinza in the U.S., and asunaprevir produced safety and efficacy rates in elderly patients similar to those observed in younger patients, according to findings published in the Journal of Hepatology.

Hidenori Toyoda, MD, PhD, department of gastroenterology, Ogaki Municipal Hospital, Japan, and colleagues compared tolerability and efficacy of a DAA treatment regimen of 60 mg once daily Daklinza (daclatasvir, Bristol-Myers Squibb) and 100 mg twice daily asunaprevir (Bristol-Myers Squibb) initiated in 115 patients with HCV genotype 1b aged 80 years or older, with a control group that consisted of 151 patients aged older than 70 years and 115 patients aged younger than 70 years.

One-year mortality and morbidity rates for patients aged more than 80 years were also compared between patients who achieved sustained virologic response and propensity score-matched patients with persistent HCV.

“The age of patients with HCV infection is increasing in Japan, with the majority above 70 years … it is urgent to clarify whether DAAs can eradicate HCV in elderly patients,” the researchers wrote.

Among patients aged older than 80 years, the SVR rate was 96.5%, which was comparable to that of patients aged older than 70 years (95.4%) and patients aged younger than 70 years (93.9%).

Treatment discontinuation rates were also similar among patients aged older than 80 years (2.6%) and patients aged older than 70 years (1.3%) and patients aged less than 70 years (0.9%).

One-year mortality was lower for patients who achieved SVR (2.7%) compared with patients with persistent HCV (15.3%; P = .0016). The 1-year mortality due to liver-related diseases was 8.1% in patients with persistent HCV infection who were aged older than 80 years; no patients who achieved SVR died from liver disease-related causes within 1-year after treatment ended.

Mild adverse events were observed in all three groups and included headache, pyrexia and nasopharyngitis. The prevalence of these events did not differ between the groups, the researchers noted.

“IFN-free therapy with oral direct-acting antiviral drugs … 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,” the researchers concluded, adding that there was a survival benefit from the eradication of HCV even among patients aged older than 80 years. – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.