Direct-acting antivirals are effective for chronic hepatitis C treatment in elderly patients: a real-world study of 17 487 patients.
Direct-acting antivirals are effective for chronic hepatitis C treatment in elderly patients: a real-world study of 17 487 patients.
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DOI：
10.1097/meg.0000000000000858
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发表时间：
2017-06
影响因子：
2.1
通讯作者：
Ioannou GN
中科院分区：
文献类型：
--
作者：
Su F;Beste LA;Green PK;Berry K;Ioannou GN
在美国，慢性丙型肝炎病毒（HCV）感染患者的平均年龄一直在增加。尽管HCV感染的老年患者的比例不断增加，但这一群体在HCV治疗的临床试验中代表性不足。我们的目的是描述直接作用抗病毒药物（DAA）在老年患者中的实际有效性。我们回顾性地确定了2014年1月1日至2015年6月30日期间在退伍军人事务医疗保健系统中开始接受索非布韦，ledipasvir/sofosbuvir或paritaprevir/ombitasvir/ritonavir/dasabuvir治疗的17487例HCV感染患者。我们确定了55岁以下、55-59岁、60-64岁、65-69岁、70-74岁和75岁或以上患者的持续病毒学应答（SVR）率，并进行了多变量logistic回归，以确定年龄是否预测SVR。总体未校正SVR率为91.2% [95%置信区间（CI）：89.7-92.4]，89.8%（95% CI：88.8-90.7），90.8%（95% CI：90.1-91.6），91.1%在55岁以下、55-59岁、60-64岁、65-69岁、70-74岁和75岁或以上的患者中，为90.0%（95% CI：86.9-92.4）和93.8%（95% CI：88.8-96.7）。在按基因型、治疗方案、肝病分期和治疗经验分层后，所有年龄组的未校正SVR率相似。在多变量模型中，调整混杂因素后，年龄不能预测SVR。DAA在所有年龄组中产生高SVR率，包括我们最大年龄组（≥75岁）的患者。高龄本身不应被视为开始DAA治疗的障碍。
The mean age of patients with chronic hepatitis C virus (HCV) infection in the USA has been increasing. Despite the increasing proportion of HCV-infected elderly patients, this group is under-represented in clinical trials of HCV treatment. We aimed to describe the real-world effectiveness of direct-acting antivirals (DAAs) among elderly patients. We retrospectively identified 17 487 HCV-infected patients who were started on treatment with sofosbuvir, ledipasvir/sofosbuvir, or paritaprevir/ombitasvir/ritonavir/dasabuvir-based regimens in the Veterans Affairs Healthcare System between 1 January 2014 and 30 June 2015. We ascertained sustained virologic response (SVR) rates in patients aged below 55, 55–59, 60–64, 65–69, 70–74, and 75 years or older and performed multivariable logistic regression to determine whether age predicted SVR. Overall unadjusted SVR rates were 91.2% [95% confidence interval (CI): 89.7–92.4], 89.8% (95% CI: 88.8–90.7), 90.8% (95% CI: 90.1–91.6), 91.1% (95% CI: 90.1–91.9), 90.0% (95% CI: 86.9–92.4), and 93.8% (95% CI: 88.8–96.7) in patients aged below 55, 55–59, 60–64, 65–69, 70–74, and 75 years or older. Unadjusted SVR rates were similar in all age groups after stratifying by genotype, treatment regimen, stage of liver disease, and treatment experience. In multivariate models, age was not predictive of SVR after adjusting for confounders. DAAs produce high rates of SVR in all age groups, including patients in our oldest age category (≥75 years). Advanced age in and of itself should not be considered a barrier to initiating DAA treatment.