The elderly and direct antiviral agents: Constraint or challenge?

Area of Science:

• Hepatology
• Geriatric Medicine
• Pharmacology

Background:

• Direct antiviral agents (DAAs) demonstrate high efficacy and safety for chronic hepatitis C.
• Limited data exist on DAA utilization in elderly populations.

Purpose of the Study:

• To evaluate the management, safety, and outcomes of DAA treatments in elderly individuals.
• To compare DAA treatment outcomes between different age groups within the elderly population.

Main Methods:

• Retrospective, single-center study of patients aged 65 years and older who completed DAA therapy.
• Patients were stratified into two groups: 65-74 years (Group A) and ≥75 years (Group B).
• Analysis included assessment of adverse events, drug interactions, and sustained virological response at 12 weeks (SVR-12).

Main Results:

• 221 elderly patients received DAAs, with 130 in Group A and 91 in Group B.
• Adverse events (AEs) occurred in 130 patients, with 13 serious AEs (SAEs), more frequent in older subjects.
• Factors associated with AEs included female sex, liver stiffness, and use of simeprevir and ribavirin.
• A high SVR-12 rate of 96.9% was achieved across the study population.

Conclusions:

• DAA treatment is effective in elderly patients with chronic hepatitis C, achieving high SVR-12 rates.
• Close monitoring and baseline evaluation are crucial for optimizing DAA management and safety in older adults.
• Specific patient characteristics and drug choices can influence the occurrence of adverse events.