Generic placeholder image

Recent Advances in Anti-Infective Drug Discovery

Editor-in-Chief

ISSN (Print): 2772-4344
ISSN (Online): 2772-4352

Research Article

Treatment of Chronic Hepatitis C Virus Using Direct Acting Antivirals in Geriatric Egyptian Patients

Author(s): Mahmoud Elkadeem* and Shoman Rabeei Shoman

Volume 16 , Issue 2 , 2021

Published on: 16 July, 2021

Page: [157 - 165] Pages: 9

DOI: 10.2174/2772434416666210716123909

Price: $65

Abstract

Background & Aims: There is high proportion of geriatric patients who acquired chronic hepatitis C virus infection. There is a shortage in evidence- based data as regards direct-acting antivirals in this group of patients. The aim was to assess safety, efficacy, and tolerability of direct acting antiviral drugs in Egyptian geriatric patients.

Methods: This prospective study was performed on 177 patients with chronic hepatitis C and administrated different regimens of direct acting antivirals. Patients were divided into two groups: Group I: patients below 65 years old (N = 143), and Group II: patients > 65 years old (N = 34). Pretreatment history taking, baseline characteristics, and investigations were done for both groups. Follow up was made to detect treatment efficacy and adverse effects.

Results: Geriatric group were found to have more comorbidities (diabetes mellitus, hypertension, and cardiomyopathy); also liver cirrhosis. Minor adverse effects occurred in both groups without significant difference included fatigue, insomnia, headache, and dizziness. Vomiting, diarrhea, and skin rash occurred in group II more than group I. Leucopenia, thrombocytopenia, jaundice, and significant anemia occurred without significant difference between both groups. Eighteen patients (25%) of 72 patients who took ribavirin had to reduce ribavirin dose or to stop it. The overall treatment response in the entire study was 97.7% without significant difference between both groups.

Conclusion: Direct acting antivirals are recommended regardless the age. These drugs are effective and tolerable in elderly patients. Attention to other comorbidities, drug-drug interactions, and follow up are recommended.

Keywords: Hepatitis C virus, direct acting antivirals, geriatric patients, ribavirin, chronic infection, vomiting.

Graphical Abstract
[1]
Westbrook RH, Dusheiko G. Natural history of hepatitis C. J Hepatol 2014; 61(1): S58-68.
[http://dx.doi.org/10.1016/j.jhep.2014.07.012] [PMID: 25443346]
[2]
Ravi S, Nasiri-Toosi M, Karimzadeh I, Khalili H, Ahadi-Barzoki M, Dashti-Khavidaki S. Pattern and associated factors of anti-hepatitis C virus treatment-induced adverse reactions. Expert Opin Drug Saf 2014; 13(3): 277-86.
[http://dx.doi.org/10.1517/14740338.2014.866091] [PMID: 24386997]
[3]
Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013; 57(4): 1333-42.
[http://dx.doi.org/10.1002/hep.26141] [PMID: 23172780]
[4]
Armstrong GL, Alter MJ, McQuillan GM, Margolis HS. The past incidence of hepatitis C virus infection: Implications for the future burden of chronic liver disease in the United States. Hepatology 2000; 31(3): 777-82.
[http://dx.doi.org/10.1002/hep.510310332] [PMID: 10706572]
[5]
Smith BD, Morgan RL, Beckett GA, Falck-Ytter Y, Holtzman D, Ward JW. Hepatitis C virus testing of persons born during 1945-1965: Recommendations from the centers for disease control and prevention. Ann Intern Med 2012; 157(11): 817-22.
[http://dx.doi.org/10.7326/0003-4819-157-9-201211060-00529] [PMID: 22910836]
[6]
Trifan A, Stanciu C, Gheorghe L, et al. Efficacy and safety of paritaprevir/ritonavir, ombitasvir, and dasabuvir with ribavirin for the treatment of HCV genotype 1b compensated cirrhosis in patients aged 70 years or older. Medicine 2017; 96(50): e9271.
[http://dx.doi.org/10.1097/MD.0000000000009271] [PMID: 29390377]
[7]
Lawitz E, Mangia A, Wyles D, et al. Sofosbuvir for previously untreated chronic hepatitis C infection. N Engl J Med 2013; 368(20): 1878-87.
[http://dx.doi.org/10.1056/NEJMoa1214853] [PMID: 23607594]
[8]
Denniston MM, Jiles RB, Drobeniuc J, et al. Chronic hepatitis C virus infection in the United States, national health and nutrition examination survey 2003 to 2010. Ann Intern Med 2014; 160(5): 293-300.
[http://dx.doi.org/10.7326/M13-1133] [PMID: 24737271]
[9]
Abdel-Aziz F, Habib M, Mohamed MK, et al. Hepatitis C virus (HCV) infection in a community in the Nile Delta: Population description and HCV prevalence. Hepatology 2000; 32(1): 111-5.
[http://dx.doi.org/10.1053/jhep.2000.8438] [PMID: 10869297]
[10]
Saab S, Rheem J, Sundaram V. Hepatitis C infection in the elderly. Dig Dis Sci 2015; 60(11): 3170-80.
[http://dx.doi.org/10.1007/s10620-015-3717-6] [PMID: 26008618]
[11]
Yang Z, Zhuang L, Yang L, et al. Efficacy and safety of peginterferon plus ribavirin for patients aged ≥ 65 years with chronic hepatitis C: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2014; 38(4): 440-50.
[http://dx.doi.org/10.1016/j.clinre.2013.08.013] [PMID: 24176812]
[12]
Roeder C, Jordan S, Schulze Zur Wiesch J, et al. Age-related differences in response to peginterferon alfa-2a/ribavirin in patients with chronic hepatitis C infection. World J Gastroenterol 2014; 20(31): 10984-93.
[http://dx.doi.org/10.3748/wjg.v20.i31.10984] [PMID: 25152602]
[13]
Sherigar JM, Gayam V, Khan A, et al. Clinical efficacy and tolerability of direct-acting antivirals in elderly patients with chronic hepatitis C. Eur J Gastroenterol Hepatol 2017; 29(7): 767-76.
[http://dx.doi.org/10.1097/MEG.0000000000000871] [PMID: 28346233]
[14]
CKD-EPI creatinine equation. 2009. Available from: https://www.kidney.org/conte nt/ckd-epi-creatinineequation-2009. (Accessed on: January 2018).
[15]
Common terminology criteria for adverse events. 2012. Available from: https://evs. nci. nih. gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf.
[16]
Gramenzi A, Conti F, Camma C, Grieco A, Picciotto A, Furlan C. Hepatitis C Virus-related chronic liver disease in elderly patients: An Italian cross-sectional study. J Viral Hepat 2010; 17(5): 360-6.
[http://dx.doi.org/10.1111/j.1365-2893.2009.01189.x] [PMID: 19758274]
[17]
Conti F, Brillanti S, Buonfiglioli F, et al. Safety and efficacy of direct-acting antivirals for the treatment of chronic hepatitis C in a real-world population aged 65 years and older. J Viral Hepat 2017; 24(6): 454-63.
[http://dx.doi.org/10.1111/jvh.12663] [PMID: 27976461]
[18]
Younossi ZM, Stepanova M, Nader F, Henry L. Patient-reported outcomes of elderly adults with chronic hepatitis C treated with interferon- and ribavirin-free regimens. J Am Geriatr Soc 2016; 64(2): 386-93.
[http://dx.doi.org/10.1111/jgs.13928] [PMID: 26825683]
[19]
AASLD/IDSA. Initial treatment of HCV infection. Recommendations for testing, management, and treating hepatitis C. 2016. Available from: http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection.
[20]
Pan CQ, Gayam V, Rabinovich C, et al. Efficacy of direct acting antivirals for chronic hepatitis C in a large cohort of older adults in the United States. J Am Geriatr Soc 2020; 68(2): 379-87.
[http://dx.doi.org/10.1111/jgs.16206]
[21]
El-Serag HB, Kramer J, Duan Z, Kanwal F. Epidemiology and outcomes of hepatitis C infection in elderly US Veterans. J Viral Hepat 2016; 23(9): 687-96.
[http://dx.doi.org/10.1111/jvh.12533] [PMID: 27040447]
[22]
Su F, Beste LA, Green PK, Berry K, Ioannou GN. Direct-acting antivirals are effective for chronic hepatitis C treatment in elderly patients: A real-world study of 17 487 patients. Eur J Gastroenterol Hepatol 2017; 29(6): 686-93.
[http://dx.doi.org/10.1097/MEG.0000000000000858] [PMID: 28195877]
[23]
Ahmed OA, Elsebaey MA, Fouad MHA, et al. Outcomes of treatment and predictors of response to sofosbuvir plus simeprevir in hepatitis C virus with genotype-4 infection. Infect Disord Drug Targets 2020; 20(3): 389-95.
[http://dx.doi.org/10.2174/1871526519666181218104600] [PMID: 30569878]
[24]
World Health Organization (WHO). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011. Available from: http://www.who.int.
[25]
Villani R, Donatiello I, Barone F, et al. Efficacy and safety of direct-acting antivirals in elderly with chronic hepatitis C: Results from a retrospective cohort study. J Genet Genomics 2018; 66: 46-55.
[26]
Pernas B. Paper presented at International Conference on Viral Hepatitis (ICVH) 2016. 2016. Available from: https://www.iapac.org/conferences/icvh/icvh-2016.
[27]
Attia D, El Saeed K, Elakel W, et al. The adverse effects of interferon-free regimens in 149 816 chronic hepatitis C treated Egyptian patients. Aliment Pharmacol Ther 2018; 47(9): 1296-305.
[http://dx.doi.org/10.1111/apt.14538] [PMID: 29504152]
[28]
Saab S, Park SH, Mizokami M, et al. Safety and efficacy of ledipasvir/sofosbuvir for the treatment of genotype 1 hepatitis C in subjects aged 65 years or older. Hepatology 2016; 63(4): 1112-9.
[http://dx.doi.org/10.1002/hep.28425] [PMID: 26704693]
[29]
Pariente A, Arpurt JP, Remy AJ, et al. Effects of age on treatment of chronic hepatitis C with direct acting antivirals. Ann Hepatol 2019; 18(1): 193-202.
[http://dx.doi.org/10.5604/01.3001.0012.7912] [PMID: 31113590]
[30]
Lens S, Fernández I, Rodríguez-Tajes S, et al. Interferon-free therapy in elderly patients with advanced liver disease. Am J Gastroenterol 2017; 112(9): 1400-9.
[http://dx.doi.org/10.1038/ajg.2017.157] [PMID: 28585554]
[31]
Ezzelregal IN, Elraie FM, Shaqueer MM, Elmola K. Effect of successful direct acting antivirals therapy on liver stiffness in patients with chronic HCV infection. Int J MedArts 2020; 2(4): 854-9.
[http://dx.doi.org/10.21608/ijma.2020.23053.1138]

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy