PMID- 31033122
OWN - NLM
STAT- MEDLINE
DCOM- 20201009
LR  - 20201009
IS  - 1478-3231 (Electronic)
IS  - 1478-3223 (Linking)
VI  - 39
IP  - 9
DP  - 2019 Sep
TI  - Efficacy and safety of direct-acting antivirals for hepatitis C in the elderly: A 
      systematic review and meta-analysis.
PG  - 1652-1660
LID - 10.1111/liv.14126 [doi]
AB  - BACKGROUND&AIMS: Since the introduction of direct-acting antivirals (DAAs) 
      several studies have reported high efficacy and safety in Hepatitis C infected 
      patients, even in those earlier considered difficult-to-treat. We aimed to assess 
      the efficacy and safety of DAA therapy in elderly patients. METHODS: The PubMed 
      MEDLINE, Embase and Cochrane databases were searched through July 2018. Two 
      independent researchers extracted data and assessed the quality and risk of bias. 
      Risk ratios (RRs) were pooled using random effects models. The primary outcome 
      was efficacy of DAA therapy assessed by the RR for non-sustained virologic 
      response (SVR) among patients aged <65 vs >/=65 years. RESULTS: Overall, we 
      identified 63 studies including 34 082 patients treated with different DAAs. Risk 
      for non-SVR was comparable in patients <65 and >/=65 years of age (RR 1.00, 95% CI 
      0.86-1.15; P = 0.979) and even lower in a subgroup analysis of cirrhotic patients 
      >/=65 years of age (RR 0.59, 95% CI 0.35-0.99, P = 0.044). Risk for non-SVR was 
      similar between age groups in all other subgroup analyses. Elderly patients had a 
      significantly increased risk of adverse events (AEs) (RR 1.30, 95% CI 1.11-1.52, 
      P = 0.001), but not for serious adverse events (P = 0.43) or treatment 
      discontinuation (P = 0.15). Risk for anaemia if treated with additional ribavirin 
      was 2.84 (95% CI 1.73-4.66, P < 0.001) in elderly patients compared to patients 
      <65 years. CONCLUSION: Our results show that DAAs are highly effective and safe 
      in elderly patients. Ribavirin should be avoided in the elderly as more AEs and 
      particularly anaemia is observed. Further cost-effectiveness analyses are needed 
      to evaluate the socio-economic benefit of treating elderly people without 
      advanced liver disease.
CI  - (c) 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
FAU - Mucke, Marcus M
AU  - Mucke MM
AUID- ORCID: 0000-0001-8475-8369
AD  - Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am 
      Main, Germany.
FAU - Herrmann, Eva
AU  - Herrmann E
AD  - Institute of Biostatistics and Mathematical Modeling, Goethe University, 
      Frankfurt am Main, Germany.
FAU - Mucke, Victoria T
AU  - Mucke VT
AD  - Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am 
      Main, Germany.
FAU - Graf, Christiana
AU  - Graf C
AD  - Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am 
      Main, Germany.
FAU - Zeuzem, Stefan
AU  - Zeuzem S
AD  - Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am 
      Main, Germany.
FAU - Vermehren, Johannes
AU  - Vermehren J
AD  - Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am 
      Main, Germany.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20190515
PL  - United States
TA  - Liver Int
JT  - Liver international : official journal of the International Association for the 
      Study of the Liver
JID - 101160857
RN  - 0 (Antiviral Agents)
RN  - 49717AWG6K (Ribavirin)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Anemia/*chemically induced
MH  - Antiviral Agents/adverse effects/*therapeutic use
MH  - Hepatitis C, Chronic/*drug therapy
MH  - Humans
MH  - Randomized Controlled Trials as Topic
MH  - Ribavirin/*adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Hepatitis C virus
OT  - direct-acting antiviral therapy
OT  - old age
EDAT- 2019/04/30 06:00
MHDA- 2020/10/10 06:00
CRDT- 2019/04/30 06:00
PHST- 2019/03/29 00:00 [received]
PHST- 2019/04/19 00:00 [accepted]
PHST- 2019/04/30 06:00 [pubmed]
PHST- 2020/10/10 06:00 [medline]
PHST- 2019/04/30 06:00 [entrez]
AID - 10.1111/liv.14126 [doi]
PST - ppublish
SO  - Liver Int. 2019 Sep;39(9):1652-1660. doi: 10.1111/liv.14126. Epub 2019 May 15.