TY - JOUR
T1 - Efficacy and safety of direct-acting antivirals in older patients with cirrhosis and high comorbidity index
AU - Amoros-Reboredo, Patricia
AU - Sotoca, Josep Miquel
AU - Mariño, Zoe
AU - Rodríguez-Tajes, Sergio
AU - Pocurull, Anna
AU - Soy, Dolors
AU - Forns, Xavier
AU - Lens, Sabela
N1 - Funding Information:
X.F. received support in part by Instituto de Salud Carlos III (PI18/00079), Ministerio de Economía y Competitividad, co-funded by Fondo Europeo de Desarrollo Regional, Unión Europea, Una manera de hacer Europa. X.F. also received a grant from Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (grant 2017_ SGR_1753). S.L., Z.M. and X.F. also received support by the Spanish Health Ministry (Plan Estratégico Nacional contra la Hepatitis C). CIBERehd is funded by the Instituto de Salud Carlos III. SRT received a Rio Ortega grant CM17/00015 (ISCIII) and research grants from the Catalonian Society of Digestology and the Hospital Clínic Barcelona.
Funding Information:
X.F. received unrestricted grant support from Abbvie and has acted as advisor for Abbvie, and Gilead. S.L. has acted as advisor for Abbvie, Janssen, and Gilead. Z.M. has acted as advisor for BMS. There are no conflicts of interest for the remaining authors.
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Objective There is scarce data with regard to the effectiveness and safety of direct-acting antivirals and possible drug-drug interactions between antiviral therapy and the multiple drugs frequently assumed by older patients. The aim is to evaluate the impact of comorbidities and drug-drug interactions on the efficacy and tolerability of direct-acting antivirals in this population. Methods Observational retrospective study of patients at least 65 years old receiving all-oral antiviral therapy between April 2015 and March 2016. Results Two hundred sixty-one patients were identified. Age distribution: 65-74 (73.9%), 75-79 (18.4%) and =80 (7.7%) years. Average age was 71 years, 38.7% were male, and 90% of patients took concomitant medication (43% patients taking = 5 medicines). Predicted clinically significant drug-drug interactions were present in 72.8% of patients. The sustained viral response 12 weeks after end of treatment was 96.9%. Patients with serious adverse events received more concomitant drugs and all of them presented a clinical risk group =06/5. Conclusions Direct antiviral agents are highly effective also in older patients with advanced liver disease, comorbidities and concomitant medications. Serious adverse events increased with the number of concomitant medications and the severity of comorbidity. A clinical risk group score =06/5 may help to decide the indication of antiviral therapy in this difficult-to-treat population.
AB - Objective There is scarce data with regard to the effectiveness and safety of direct-acting antivirals and possible drug-drug interactions between antiviral therapy and the multiple drugs frequently assumed by older patients. The aim is to evaluate the impact of comorbidities and drug-drug interactions on the efficacy and tolerability of direct-acting antivirals in this population. Methods Observational retrospective study of patients at least 65 years old receiving all-oral antiviral therapy between April 2015 and March 2016. Results Two hundred sixty-one patients were identified. Age distribution: 65-74 (73.9%), 75-79 (18.4%) and =80 (7.7%) years. Average age was 71 years, 38.7% were male, and 90% of patients took concomitant medication (43% patients taking = 5 medicines). Predicted clinically significant drug-drug interactions were present in 72.8% of patients. The sustained viral response 12 weeks after end of treatment was 96.9%. Patients with serious adverse events received more concomitant drugs and all of them presented a clinical risk group =06/5. Conclusions Direct antiviral agents are highly effective also in older patients with advanced liver disease, comorbidities and concomitant medications. Serious adverse events increased with the number of concomitant medications and the severity of comorbidity. A clinical risk group score =06/5 may help to decide the indication of antiviral therapy in this difficult-to-treat population.
KW - antiviral
KW - comorbidity
KW - hepatitis C
KW - older
UR - http://www.scopus.com/inward/record.url?scp=85078868420&partnerID=8YFLogxK
UR - https://www.webofscience.com/wos/woscc/full-record/WOS:000528832400015?SID=EUW1ED0E70ECgAmg8vb3ZwbcOy7jo
U2 - 10.1097/MEG.0000000000001518
DO - 10.1097/MEG.0000000000001518
M3 - Article
C2 - 31441796
AN - SCOPUS:85078868420
SN - 0954-691X
VL - 32
SP - 389
EP - 394
JO - European Journal of Gastroenterology and Hepatology
JF - European Journal of Gastroenterology and Hepatology
IS - 3
ER -