Rodríguez-Osorio Iria, Cid Purificación, Morano Luis, Castro Ángeles, Suárez Marta, Delgado Manuel, Margusino Luis, Meijide Héctor, Pernas Berta, Tabernilla Andrés, Pedreira José D, Mena Álvaro, Poveda Eva
Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Spain.
Unidad de Patología Infecciosa, Servicio de Medicina Interna, Hospital Álvaro Cunqueiro, Complejo Universitario de Vigo, Spain.
J Clin Virol. 2017 Mar;88:58-61. doi: 10.1016/j.jcv.2017.01.003. Epub 2017 Jan 18.
New direct-acting antivirals agents (DAAs) are very safe and well tolerated.
The purpose of this study is to analyse the efficacy and safety of DAAs in elderly patients, who have co-morbidities and are on chronic medications.
All HCV-infected patients over 65 years old in clinical follow-up at two Hospitals in Spain who initiated anti-HCV therapy were included (August 2012-October 2015).
A total of 120 HCV mono-infected patients were recorded. Mean age of patients was 72.6±7.4years. There were 53.3% women and GT1b was the most frequent (83.3%); 64.2% had cirrhosis and 42.5% were treatment experienced. Ombitasvir+Paritaprevir/r±Dasabuvir±Ribavirin (RBV) and sofosbuvir/ledipasvir±RBV were the most frequently used regimens. Weight-adjusted dosing of RBV was included in 61.7% and 43.6% of them required a dose reduction. Most of the patients (86.7%) had concomitant chronic medication and in 35.8% adjustment was necessary. Adverse events (AE) were seen in 65% of the patients; more frequent when a protease inhibitor (PI) was being used. The sustained virological response (SVR12) per ITT was 88.3%. Only 3 patients discontinued treatment and 2 patients died.
High rates of SVR12 (88.3%) were observed among elderly patients with DAAs-based regimens. The presence of AE was frequent (65%). The majority of these patients (86.7%) had concomitant medication that required adjustment in 1/3 of them. These findings highlight the high rates of response to DAAs in the elderly HCV-population. However, special caution must be taken when using RBV and a PI.
新型直接抗病毒药物（DAA）非常安全且耐受性良好。
本研究旨在分析DAA在患有合并症且正在服用慢性药物的老年患者中的疗效和安全性。
纳入西班牙两家医院临床随访中所有65岁以上开始抗丙型肝炎病毒（HCV）治疗的HCV感染患者（2012年8月至2015年10月）。
共记录了120例HCV单感染患者。患者的平均年龄为72.6±7.4岁。女性占53.3%，基因1b型最常见（83.3%）；64.2%有肝硬化，42.5%有治疗史。奥比他韦+帕利瑞韦/利托那韦±达沙布韦±利巴韦林（RBV）和索磷布韦/维帕他韦±RBV是最常用的方案。61.7%的患者采用了根据体重调整剂量的RBV，其中43.6%需要减量。大多数患者（86.7%）同时服用慢性药物，35.8%的患者需要调整剂量。65%的患者出现了不良事件（AE）；使用蛋白酶抑制剂（PI）时更常见。意向性分析（ITT）的持续病毒学应答（SVR12）率为88.3%。仅3例患者停药，有2例患者死亡。
在接受基于DAA方案治疗的老年患者中观察到较高的SVR12率（88.3%）。AE的发生很常见（65%）。这些患者中的大多数（86.7%）同时服用其他药物，其中1/3需要调整。这些发现凸显了老年HCV人群对DAA的高应答率。然而，使用RBV和PI时必须格外谨慎。
