Treating hepatitis C in the elderly: pharmacotherapeutic considerations and developments

ABSTRACT

Introduction: The seroprevalence of hepatitis C virus (HCV) infection tends to be higher in the elderly than in younger populations. Meanwhile, age per sec is an unfavorable determinant that has an impact on liver-related outcomes. Geriatric chronic hepatitis C (CHC) patients would be viewed as a special population and have an urgent need for viral eradication.

Areas covered: The antivirals for CHC have evolved from interferon (IFN)-based therapyto interferon-free DAAs. The treatment strategy, in terms of its clinical efficacy and drug safety, in the elderly is presented.

Expert opinion: In the previous IFN era, the sustained virological response (SVR) rate of the elderly was lower. More unfavorable safety concerns attributing to the underlying liver disease severity and extra-hepatic presentations further compromised the treatment efficacy. In the IFN-free DAA era, data showing similar SVR rates and safety profiles between the elderly and their counterparts have been demonstrated. Notably, aging is an unfavorable factor for fibrosis regression and HCC development even after HCV eradication. The extent of the improvement of extra-hepatic manifestations in the elderly with SVR is also unclear. The long-term benefits of viral eradication by DAAs in the elderly await further explorations.

KEYWORDS:

• DAA
• elderly
• HCV
• IFN
• advanced age
• treatment

Article highlights

• Higher seroprevalence of HCV in the elderly in some countries in the past decades. Increasing patient numbers in baby-boomers.

• More acceleration of fibrosis with aging, and a higher risk of HCC development in the elderly.

• A lower SVR rate of the elderly in the IFN era, in particular for patients with HCV-1/4 infection. An Equal SVR rate compared with their younger counterparts in the DAA era regardless underlying disease severity and co-morbidities.

• More unfavorable safety profiles of the elderly in the IFN era, which have been overcome in the DAA era. However, More DDIs issues have to be solved in the DAA era.

• Slower fibrosis regression and residual HCC risk in the elderly after achieving SVR in the IFN era. Long-term outcomes are to be elucidated in the DAAs era.

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Declaration of interest

M-L Yu declares research support from Abbvie, Abbott, BMS, Gilead, Merck and Roche and has acted as a consultant of Abbvie, Abbott, Ascletis, BMS, Gilead, J&J, Merck, Novartis, Pharmaessential and Roche and a speaker of Abbvie, Abbott, Ascletis, BMS, Gilead, Merck, Pharmaessential and Roche. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This study was supported by the grants from the Kaohsiung Medical University Hospital [KMUH104-4R06] and National Science Council of Taiwan [MOST 103-2314-B-037-055-MY3].