Premium
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
Author(s) -
Vermehren J.,
Peiffer K.H.,
Welsch C.,
Grammatikos G.,
Welker M.W.,
Weiler N.,
Zeuzem S.,
Welzel T. M.,
Sarrazin C.
Publication year - 2016
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13769
Subject(s) - sofosbuvir , medicine , ombitasvir , daclatasvir , paritaprevir , dasabuvir , ribavirin , ledipasvir , simeprevir , tolerability , concomitant , hepatitis c , gastroenterology , adverse effect , hepatitis c virus , virology , virus
Summary Background Direct antiviral therapies for chronic hepatitis C virus ( HCV ) infection have expanded treatment options for neglected patient populations, including elderly patients who are ineligible/intolerant to receive interferon ( IFN )‐based therapy. Aim To investigate the efficacy, tolerability and potential for drug–drug interactions ( DDI s) of IFN ‐free treatment in patients aged ≥65 years in a large real‐world cohort. Methods A total of 541 patients were treated with different combinations of direct antiviral agents ( DAA s: ledipasvir/sofosbuvir ±ribavirin; daclatasvir/sofosbuvir ±ribavirin; paritaprevir/ombitasvir ±dasabuvir ±ribavirin or simeprevir/sofosbuvir ±ribavirin in genotype 1/4, and daclatasvir/sofosbuvir ±ribavirin or sofosbuvir/ribavirin in genotype 2/3). Efficacy, safety and potential DDI s were analysed and compared between patients aged <65 years ( n = 404) and patients aged ≥65 years ( n = 137) of whom 41 patients were ≥75 years. Results Sustained virological response rates were 98% and 91% in patients aged ≥65 years and <65 years, respectively. Elderly patients took significantly more concomitant medications (79% vs. 51%; P < 0.0001). The number of concomitant drugs per patient was highest in patients ≥65 years with cirrhosis (median, three per patient; range, 0–10). Based on the hep‐druginteractions database, the proportion of predicted clinically significant DDI s was significantly higher in elderly patients (54% vs. 28%; P < 0.0001). The number of patients who experienced treatment‐associated adverse events was similar between the two age groups (63% vs. 65%; P = n.s.). Conclusions Elderly patients are at increased risk for significant DDI s when treated with DAA s for chronic HCV infection. However, with careful pre‐treatment assessment of concomitant medications, on‐treatment monitoring or dose‐modifications, significant DDI s and associated adverse events can be avoided.