title: Efficacy and tolerability of an IFN-free regimen with DCV/ASV for elderly patients infected with HCV genotype 1B.
abstract: 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).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan. Electronic address: hmtoyoda@spice.ocn.ne.jp.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.affiliation: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.affiliation: Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.affiliation: Department of Gastroenterology, Otakano-mori Hospital, Kashiwa, Japan.
authors.forename: Noritomo
authors.initials: N
authors.lastname: Shimada
authors.affiliation: Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Takaguchi
authors.affiliation: Department of Hepatology, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Senoh
authors.affiliation: Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Tsuji
authors.affiliation: Department of Gastroenterology and Hepatology, Komaki City Hospital, Komaki, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Tachi
authors.affiliation: Department of Gastroenterology, Ehime Prefectural Central Hospital, Matsuyama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hiraoka
authors.affiliation: Department of Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Gastroenterology, Saiseikai Suita Hospital, Osaka, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Shima
authors.affiliation: Department of Gastroenterology, Saiseikai Suita Hospital, Osaka, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okanoue
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002219:Carbamates; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage; D007372:Interferons / Q000008:administration & dosage; D007546:Isoquinolines / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011759:Pyrrolidines; D013449:Sulfonamides / Q000008:administration & dosage; D000072230:Sustained Virologic Response; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D002219:Carbamates; D007093:Imidazoles; D007546:Isoquinolines; D011759:Pyrrolidines; D013449:Sulfonamides; D007372:Interferons; D014633:Valine; C549273:daclatasvir; C571889:asunaprevir
keywords: Aged patients; Chronic hepatitis C; Direct-acting antiviral; Sustained virologic response; Tolerability