Direct-acting antiviral (DAA) therapy has changed the face of treatment for hepatitis C virus (HCV). Modern treatment is safe, generally well tolerated and cures most treated individuals. But its effectiveness and safety in older people, who make up a large proportion of the population with HCV, warrants further investigation.
To this end, Jeong-Ju Yoo, MD, PhD, of Soonchunhyang University Bucheon Hospital in South Korea, and colleagues conducted a meta-analysis to assess the safety and efficacy of direct-acting antivirals in older individuals living with hepatitis C.
The team carried out a detailed search of MEDLINE, Embase, OVID MEDLINE, Cochrane Library and other databases. They looked at rates of adverse events and sustained virologic response (SVR)—an undetectable HCV viral load 12 weeks or more after completing treatment—which is considered a cure.
Ultimately, the researchers included 90 studies in which SVR rates were reported for individuals at least 65 years old who had received antiviral therapy for HCV. They found that 96% of elderly individuals attained SVR, meaning the cure rate was similar for older and younger people.
The overall rate of adverse events was 45%, with their frequency being slightly higher among people over 65 compared with the younger group. This was particularly evident in the case of severe adverse events. However, the rates of adverse events in the older and younger groups were similar among those who did not receive ribavirin, which is no longer routinely used for first-line HCV treatment in the United States.
“DAAs have high efficacy in elderly patients,” wrote the researchers. “Considering the possibility of adverse events, the ribavirin-free regimen should be given prior consideration for the treatment of elderly patients with HCV.”