Interferon-Free Therapy in Elderly Patients With Advanced Liver Disease
Por:
Lens, S, Fernandez, I, Rodriguez-Tajes, S, Hontangas, V, Vergara, M, Forne, M, Calleja, JL, Diago, M, Llaneras, J, Llerena, S, Torras, X, Sacristan, B, Roget, M, Fernandez-Rodriguez, CM, Navascues, MC, Fuentes, J, Sanchez-Ruano, JJ, Simon, MA, Saez-Royuela, F, Baliellas, C, Morillas, R and Forns, X
Publicada:
1 sep 2017
Resumen:
OBJECTIVES: Interferon-free therapies have an improved safety and efficacy profile. However, data in elderly patients, who have frequently advanced liver disease, associated comorbidities, and use concomitant medications are scarce. The im of this study was to assess the effectiveness and tolerability of all-oral regimens in elderly patients in real-life clinical practice.
METHODS: Retrospective analysis of hepatitis C virus (HCV) patients aged >= 65 years receiving interferon-free regimens within the Spanish National Registry (Hepa-C).
RESULTS: Data of 1,252 patients were recorded. Of these, 955 (76%) were aged 65-74 years, 211 (17%) were aged 75-79 years, and 86 (7%) were aged >= 80 years at the start of antiviral therapy. HCV genotype-1b was predominant (88%) and 48% were previous non-responders. A significant proportion of patients had cirrhosis (922; 74%), of whom 11% presented decompensated liver disease. The most used regimens were SOF/LDV (33%), 3D (28%), and SOF/SMV (26%). Ribavirin was added in 49% of patients. Overall, the sustained virological response (SVR12) rate was 94% without differences among the three age categories. Albumin <= 3.5 g/dl was the only independent negative predictor of response (0.25 (0.15-0.41); P < 0.01). Regarding tolerability, the rate of severe adverse events increased with age category (8.8, 13, and 14%; P = 0.04). In addition, the main predictors of mortality (2.3%) were age >= 75 years (2.59 (1.16-5.83); P = 0.02) and albumin <= 3.5 (17 (6.3-47); P < 0.01).
CONCLUSIONS: SVR rates with interferon-free regimens in elderly patients are high and comparable to the general population. Baseline low albumin levels (<= 3.5 g/dl) was the only predictor of treatment failure. Importantly, the rate of severe adverse events and death increased with age. Elderly patients (>= 75 years) or those with advanced liver disease (albumin <= 3.5) presented higher mortality. Thus a careful selection of patients for antiviral treatment is recommended.
Filiaciones:
Lens, S:
Univ Barcelona, CIBERehd, IDIBAPS, Hosp Clin,Liver Unit, Barcelona, Spain
Fernandez, I:
Hosp Univ 12 Octubre, Digest Dis Serv, Madrid, Spain
Rodriguez-Tajes, S:
Univ Barcelona, CIBERehd, IDIBAPS, Hosp Clin,Liver Unit, Barcelona, Spain
Hontangas, V:
Hosp La Fe Valencia, Liver Unit, Valencia, Spain
Vergara, M:
Univ Autonoma Barcelona, Hosp Univ Sabadell, Parc Tauli Sabadell, Liver Unit, Barcelona, Spain
Forne, M:
Hosp Univ Mutua Terrassa, Digest Dept, Terrassa, Spain
Calleja, JL:
Hosp Univ Puerta Hierro, Liver Unit, Madrid, Spain
Diago, M:
Hosp Gen Univ Valencia, Liver Unit, Valencia, Spain
Llaneras, J:
Hosp Valle De Hebron, Internal Med, Liver Unit, Barcelona, Spain
Llerena, S:
Marques Valdecilla Univ Hosp, Gastroenterol & Hepatol Dept, Santander, Spain
Marques Valdecilla Res Inst IDIVAL, Infect Immun & Digest Dis Grp, Santander, Spain
Torras, X:
Hosp Santa Creu & Sant Pau, CIBERehd, Liver Unit, Barcelona, Spain
Sacristan, B:
Hosp San Pedro, Gastroenterol & Hepatol Dept, Logrono, Spain
Roget, M:
Consorci Sanitari Terrassa, Liver Unit, Terrassa, Spain
Fernandez-Rodriguez, CM:
Univ Rey Juan Carlos, Hosp Univ Fdn Alcorcon, Gastroenterol & Hepatol Dept, Madrid, Spain
Navascues, MC:
Hosp Cent Asturias, Gastroenterol Div, Liver Unit, Oviedo, Spain
Fuentes, J:
Hosp Univ Miguel Servet, Gastroenterol & Hepatol Dept, Zaragoza, Spain
Sanchez-Ruano, JJ:
Hosp Univ Toledo, Gastroenterol & Hepatol Dept, Toledo, Spain
Simon, MA:
Clin Univ Zaragoza, Gastroenterol & Hepatol Dept, Zaragoza, Spain
Saez-Royuela, F:
Hosp Univ Burgos, Gastroenterol & Hepatol Dept, Burgos, Spain
Baliellas, C:
Hosp Bellvitge Princeps Espanya, Liver Unit, Barcelona, Spain
:
Hosp Germans Trias Pujol, Liver Unit, Badalona, Spain
Forns, X:
Univ Barcelona, CIBERehd, IDIBAPS, Hosp Clin,Liver Unit, Barcelona, Spain
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