无干扰素方案下 DCV/ASV 治疗老年 HCV 基因 1B 型感染患者的疗效和耐受性。
Efficacy and tolerability of an IFN-free regimen with DCV/ASV for elderly patients infected with HCV genotype 1B.
机构信息
Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
出版信息
J Hepatol. 2017 Mar;66(3):521-527. doi: 10.1016/j.jhep.2016.11.012. Epub 2016 Nov 25.
BACKGROUND & AIMS: Anti-hepatitis C virus (HCV) therapy by interferon (IFN)-free regimen with oral direct-acting antiviral drugs are tolerable in aged patients, with fewer adverse effects than IFN-based therapies. We investigated the efficacy and tolerability of an IFN-free anti-HCV therapy in extremely aged patients, as well as the survival benefit of sustained virologic response (SVR).
METHODS
Following IFN-free therapy with daclatasvir and asunaprevir, tolerability and SVR rate were compared between 115 HCV genotype 1-infected patients aged 80years or older, 151 patients in their 70s (⩾70 and <80years), and 115 patients under the age of 70. One-year mortality and morbidity in patients aged ⩾80years were compared between SVR patients and propensity score-matched patients with persistent HCV infection.
RESULTS
The SVR rate was 96.5% in patients ⩾80years, comparable to that in patients aged ⩾70 and <80years (95.4%) and patients aged <70years (93.9%). There were no differences in treatment discontinuation rate (2.6%, 1.3%, and 0.9%, respectively). One-year mortality was significantly lower in SVR patients (2.7%) than in patients with persistent HCV infection (15.3%, p=0.0016). Whereas 1-year mortality due to liver-related diseases was 8.1% in patients with persistent HCV infection who were aged ⩾80years, no SVR patients died from liver diseases within 1-year after the end of therapy.
CONCLUSIONS
IFN-free therapy for HCV infection was associated with high tolerability and antiviral efficacy, even in patients aged ⩾80years. In addition, there seemed to be a survival benefit from the eradication of HCV in this population.
LAY SUMMARY
IFN-free therapy with oral direct-acting antiviral drugs (daclatasvir and asunaprevir) for HCV infection showed similar tolerability and antiviral efficacy in patients aged ⩾80years as in younger patients (patients aged ⩾70 and <80years and patients aged <70years), with an SVR rate over 90% and no severe adverse effects. There was a survival benefit from the eradication of HCV even in patients aged ⩾80years.
背景与目的
与基于干扰素的治疗相比，无干扰素的抗病毒药物治疗方案治疗丙型肝炎病毒（HCV）在老年患者中是可以耐受的，且副作用更少。我们研究了无干扰素抗 HCV 治疗在超高龄患者中的疗效和耐受性，以及持续病毒学应答（SVR）的生存获益。
方法
在接受达卡他韦和阿昔洛韦治疗后，我们比较了 115 例年龄在 80 岁或以上的 HCV 基因型 1 感染患者、151 例 70 岁以上（≥70 岁且<80 岁）患者和 115 例 70 岁以下患者的耐受性和 SVR 率。我们比较了年龄在 80 岁或以上的 SVR 患者与持续 HCV 感染的倾向评分匹配患者之间的 1 年死亡率和发病率。
结果
年龄在 80 岁或以上的患者 SVR 率为 96.5%，与年龄在 70 岁以上且<80 岁（95.4%）和年龄在 70 岁以下（93.9%）的患者相当。停药率无差异（分别为 2.6%、1.3%和 0.9%）。SVR 患者的 1 年死亡率（2.7%）明显低于持续 HCV 感染患者（15.3%，p=0.0016）。年龄在 80 岁或以上且持续 HCV 感染的患者，1 年因肝脏相关疾病的死亡率为 8.1%，而在 SVR 患者中，没有患者在治疗结束后 1 年内死于肝脏疾病。
结论
无干扰素治疗丙型肝炎感染具有较高的耐受性和抗病毒疗效，甚至在年龄在 80 岁或以上的患者中也是如此。此外，在该人群中，从 HCV 清除中似乎获得了生存获益。
要点总结
无干扰素的口服直接抗病毒药物（达卡他韦和阿昔洛韦）治疗丙型肝炎感染在 80 岁或以上的患者中与较年轻患者（年龄在 70 岁以上且<80 岁和年龄在 70 岁以下）中具有相似的耐受性和抗病毒疗效，SVR 率超过 90%，且无严重不良反应。即使在 80 岁或以上的患者中，从 HCV 清除中也获得了生存获益。
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