Meta-analysis: DAAs safe for elderly patients with HCV

  • Mücke MM & al.
  • Liver Int
  • 29 Apr 2019

  • International Clinical Digest
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Takeaway

  • Direct-acting antivirals (DAAs) are highly effective and safe for elderly patients with HCV infection.
  • Nonserious adverse events are more common, particularly ribavirin-related anemia.

Why this matters

  • Elderly patients have an increased risk for HCV, mainly explained by high infection rates among baby-boomers born between 1945 and 1965.

Study design

  • Meta-analysis of 63 studies involving 34,082 DAA-treated patients; 15 were randomized controlled trials, 17 were prospective studies, and 28 were retrospective cohort studies.
  • Primary outcome: sustained virologic response (SVR).
  • Funding: None.

Key results

  • Pooled SVR rates were similar with age ≥65 vs
  • Non-SVR risk was comparable with age ≥65 vs 2=13%; P=.21) or publication bias.
  • In subanalysis, non-SVR risk was lower among cirrhotic patients aged ≥65 years (RR=0.59; P=.044), but similar vs age
  • Treatment-experienced (P=.880).
  • Across genotypes (P=.24).
  • Across DAA regimens (P=.14).
  • Non-SVR risk was similar with age ≥75 vs 2=11%).
  • Patients aged ≥65 years had a higher risk for adverse events (RR=1.30; P=.001), particularly ribavirin-associated anemia (RR=2.84; P<.001>
  • Risks for serious events (P=.43) and early discontinuation (P=.15) were similar.
  • Limitations

    • Some overlapping study populations.
    • Heterogeneity in adverse event reporting, regimen protocols.

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