College of Medicine, Soonchunhyang University, Cheonan, Korea.
Nowon Eulji Medical Center, Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea.
J Viral Hepat. 2022 Jul;29(7):496-517. doi: 10.1111/jvh.13679. Epub 2022 Apr 6.
Direct-acting agents (DAAs) have launched a new era of hepatitis C virus (HCV) treatment. As aged individuals comprise a large percentage of HCV-infected patients, the effectiveness and safety of DAAs in the elderly have come under scrutiny. This meta-analysis aimed to evaluate the efficacy and safety of DAAs in elderly patients. After a systematic search in PubMed (MEDLINE), Embase, OVID MEDLINE, the Cochrane Library and other databases, two investigators reviewed relevant abstracts and selected manuscripts for examination. The sustained virologic response (SVR) and adverse event (AE) rates were calculated with a random-effects model. Ninety studies evaluating SVR rates of elderly patients (≥65 years old) receiving DAAs were selected. DAAs in elderly patients exhibited a notable SVR rate of 96% (95% confidence interval [CI]: 95%-97%), accompanied by comparable rates in subgroup analyses. The comparison of SVR rates in elderly and non-elderly patients indicated no significant discrepancy (odds ratio [OR] 1.01, 95% CI: 1.00-1.01). The overall event rate of AEs was 45% (95% CI: 31%-60%), though AE rates varied by subgroups. Furthermore, AEs were comparatively more frequent (OR 1.15, 95% CI: 1.04-1.28) in the elderly than non-elderly, especially in subgroups such as SAE (OR 1.89, 95% CI: 1.52-2.36) and dose reduction in ribavirin (OR 1.90, 95% CI: 1.53-2.36). However, in the ribavirin (RBV)-free regimen, there was no significant difference in the incidence of AEs between the elderly and non-elderly groups. DAAs have high efficacy in elderly patients. Considering the possibility of AE, the RBV-free regimen should be given prior consideration for the treatment of elderly patients with HCV.
直接作用抗病毒药物（DAAs）开创了丙型肝炎病毒（HCV）治疗的新纪元。由于老年患者在 HCV 感染患者中占很大比例，因此 DAA 在老年患者中的有效性和安全性受到了关注。本荟萃分析旨在评估 DAA 在老年患者中的疗效和安全性。我们在 PubMed（MEDLINE）、Embase、OVID MEDLINE、Cochrane 图书馆和其他数据库中进行了系统检索，两位研究者对相关摘要和入选文献进行了评估。我们使用随机效应模型计算持续病毒学应答（SVR）和不良事件（AE）的发生率。我们共纳入了 90 项评估 DAA 治疗老年（≥65 岁）患者 SVR 率的研究。老年患者 DAA 治疗的 SVR 率高达 96%（95%置信区间 [CI]：95%-97%），亚组分析结果一致。老年和非老年患者 SVR 率的比较无显著差异（比值比 [OR] 1.01，95% CI：1.00-1.01）。AE 的总体发生率为 45%（95% CI：31%-60%），但不同亚组间的发生率存在差异。此外，与非老年患者相比，老年患者的 AE 发生率更高（OR 1.15，95% CI：1.04-1.28），特别是在严重不良事件（OR 1.89，95% CI：1.52-2.36）和减少利巴韦林剂量（OR 1.90，95% CI：1.53-2.36）亚组中。然而，在无利巴韦林（RBV）方案中，老年和非老年患者的 AE 发生率无显著差异。DAA 对老年患者具有较高的疗效。鉴于 AE 的可能性，对于 HCV 老年患者的治疗，应优先考虑无 RBV 方案。
