The elderly and direct antiviral agents: Constraint or challenge?

Background Direct antiviral agents (DAAs) for chronic hepatitis C showed great effectiveness and good safety profile. So far, few data are available about their use in elderly subjects. Aim To assess management, safety and outcome of DAAs treatments in the elderly. Methods This retrospective, single-centre study enrolled all patients aged ≥65 years, compared by age (group A: 65–74 years, group B: ≥75 years), who completed DAAs between February 2015–November 2016. Variables potentially associated to adverse events (AEs) were analyzed. Sustained virological response (SVR) was evaluated at 12-weeks follow-up. Results DAAs were administered to 221 patients aged ≥65 years (males: 112; group A: 130, group B: 91). Prescribed regimens were: sofosbuvir-based: 44 patients (19.9%), simeprevir-based: 25 (15%), ledipasvir-based: 49 (22.2%), daclatasvir-based: 12 (5.4%), paritaprevir/ritonavir + ombitasvir ± dasabuvir: 91 (41.2%). Ribavirin was used in 121 patients. In 58 subjects co-medications were adjusted due to drug interactions. At least one AE occurred in 130 patients, including 13 SAEs, mainly in older subjects (p = 0.04). Female sex (p = 0.04), liver stiffness (p = 0.023), use of simeprevir (p = 0.03) and ribavirin (p = 0.009) were associated with AEs. SVR-12 was achieved in 96,9% of subjects. Conclusions A careful baseline evaluation and a strict monitoring allow to optimise management and outcome of DAAs in elderly.