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Pugliese N, Polverini D, Arcari I, De Nicola S, Colapietro F, Masetti C, Ormas M, Ceriani R, Lleo A, Aghemo A. Hepatitis C Virus Infection in the Elderly in the Era of Direct-Acting Antivirals: Evidence from Clinical Trials and Real Life. Trop Med Infect Dis 2023; 8:502. [PMID: 37999621 PMCID: PMC10674442 DOI: 10.3390/tropicalmed8110502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
The introduction of direct-acting antiviral agents (DAAs) into clinical practice has revolutionized the therapeutic approach to patients with chronic hepatitis C virus (HCV) infection. According to the most recent guidelines, the first line of treatment for HCV infection involves the use of one of three pan-genotypic DAA combinations, sofosbuvir/velpatasvir (SOF/VEL), glecaprevir/pibrentasvir (GLE/PIB), and sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). These drugs have been shown to be effective and safe in numerous clinical trials and real-world studies, but special populations have been neglected. Among the special populations to be treated are elderly patients, whose numbers are increasing in clinical practice. The management of these patients can be challenging, in particular due to multiple comorbidities, polypharmacotherapy, and potential drug-drug interactions. This narrative review aims to summarize the current scientific evidence on the efficacy and safety of DAAs in the elderly population, both in clinical trials and in real-life settings. Although there is still a paucity of real-world data and no clinical trials have yet been conducted in the population aged ≥ 75 years old, some considerations about the efficacy and safety of DAAs in the elderly can be made based on the results of these studies. The pan-genotypic associations of DAAs appear to be as efficacious and safe in the elderly population as in the general population; this is both in terms of similar sustained virologic response (SVR) rates and similar frequencies of adverse events (AEs). However, further studies specifically involving this patient population would be necessary to confirm this evidence.
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Affiliation(s)
- Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Davide Polverini
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Ivan Arcari
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Stella De Nicola
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Monica Ormas
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Roberto Ceriani
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
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Tamai H, Okamura J. Risk Factors of Glecaprevir/Pibrentasvir-Induced Liver Injury and Efficacy of Ursodeoxycholic Acid. Viruses 2023; 15:v15020489. [PMID: 36851703 PMCID: PMC9962642 DOI: 10.3390/v15020489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Although glecaprevir/pibrentasvir (GP) therapy is recommended as a first-line treatment for hepatitis C virus (HCV) infection, serious drug-induced liver injury occasionally develops. The present study aimed to elucidate real-world risk factors for GP-induced liver injury and to evaluate the efficacy of add-on ursodeoxycholic acid (UDCA) for liver injury. We analyzed 236 HCV patients who received GP therapy. GP-induced liver injury was defined as any elevation to grade ≥ 1 in total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), or γ-glutamyl transferase (γ-GT) during treatment without other cause. The frequency of GP-induced liver injury was 61.9% (146/236). Serious elevation to grade ≥ 3 in TB, AST, ALT, ALP, and γ-GT was identified in 3.8% (9/236), 0%, 0%, 0%, and 0.4% (1/209), respectively. Therapy discontinuation and dose reduction were seen in one patient each. Multivariate analysis revealed age and TB as independent risk factors for GP-induced liver injury. In patients with grade ≥ 2 hyperbilirubinemia, TB after onset significantly decreased in the add-on UDCA group but not in the no UDCA group. Careful attention to GP-induced liver injury is warranted for elderly patients with cirrhosis. Add-on UDCA could suppress the aggravation of GP-induced liver injury.
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Affiliation(s)
- Hideyuki Tamai
- Correspondence: ; Tel.: +81-73-451-3181; Fax: +81-73-452-7171
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Komaki Y, Ozono Y, Nakamura K, Iwakiri H, Hasuike S, Sueta M, Miike T, Yamamoto S, Uto H, Kusumoto K, Ochiai T, Kato J, Komada N, Kuroki K, Eto T, Shigehira M, Hirono S, Nagata K, Kawakami H. Efficacy and safety of glecaprevir and pibrentasvir in Japanese patients with hepatitis C virus infection aged 75 years or older. BMC Gastroenterol 2022; 22:210. [PMID: 35484503 PMCID: PMC9052496 DOI: 10.1186/s12876-022-02284-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/14/2022] [Indexed: 12/31/2022] Open
Abstract
Background It is estimated that approximately 50% of patients with hepatitis C virus (HCV) infection in Japan are currently over 75 years old. However, patients aged ≥ 75 years are typically underrepresented in clinical trials of direct-acting antivirals. This study aimed to evaluate the efficacy and safety of glecaprevir and pibrentasvir (G/P) treatment in Japanese patients with HCV infection aged ≥ 75 years. Methods This multicenter, retrospective study included 271 Japanese patients with HCV infection from 12 centers in Miyazaki Prefecture, Japan. Demographic, clinical, virological, and adverse events (AEs) data obtained during and after G/P treatment were collected from medical records. The patients were divided into two groups: younger (n = 199, aged < 75 years) and older (n = 72, aged ≥ 75 years). Virological data and AEs were analyzed according to the age group. Results In intention-to-treat (ITT) and per-protocol analyses, the overall sustained virological response 12 (SVR12) rates were 93% and 98.8%, respectively. Two patients in the older group and 14 patients in the younger group dropped out before SVR12 assessment. Although patients in the older group tended to have liver cirrhosis, 95.8% in the older group and 92% in the younger group achieved SVR12 in the ITT analysis (P = 0.404). In total, 48 (17.7%) patients experienced treatment-related AEs. Common AEs during treatment included pruritus, headache, and fatigue. The AEs were not significantly different between the two groups. Conclusions Compared with younger patients, older patients showed similar virological response and tolerance to G/P treatment.
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Affiliation(s)
- Yuri Komaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoshinori Ozono
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kenichi Nakamura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hisayoshi Iwakiri
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Satoru Hasuike
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Mitsue Sueta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tadashi Miike
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shojiro Yamamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hirofumi Uto
- Department of Gastroenterology, Miyazaki Medical Center Hospital, Miyazaki, Japan
| | - Kazunori Kusumoto
- Department of Internal Medicine, Koga General Hospital, Miyazaki, Japan
| | - Toshimasa Ochiai
- Department of Internal Medicine, Koga General Hospital, Miyazaki, Japan
| | - Junya Kato
- Department of Internal Medicine, National Hospital Organization Miyakonojo Medical Center, Miyazaki, Japan
| | - Naoto Komada
- Department of Internal Medicine, National Hospital Organization Miyakonojo Medical Center, Miyazaki, Japan
| | - Kazuo Kuroki
- Department of Internal Medicine, Kushima Municipal Hospital, Miyazaki, Japan
| | - Toshiharu Eto
- Department of Internal Medicine, Kushima Municipal Hospital, Miyazaki, Japan
| | | | - Shuichi Hirono
- Department of Internal Medicine, Hirono Naika Clinic, Miyazaki, Japan
| | - Kenji Nagata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Kawakami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
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Takaoka Y, Miura K, Morimoto N, Ikegami T, Kakizaki S, Sato K, Ueno T, Naganuma A, Kosone T, Arai H, Hatanaka T, Tahara T, Tano S, Ohtake T, Murohisa T, Namikawa M, Asano T, Kamoshida T, Horiuchi K, Nihei T, Soeda A, Kurata H, Fujieda T, Ohtake T, Fukaya Y, Iijima M, Watanabe S, Isoda N, Yamamoto H. Real-world efficacy and safety of 12-week sofosbuvir/velpatasvir treatment for patients with decompensated liver cirrhosis caused by hepatitis C virus infection. Hepatol Res 2021; 51:51-61. [PMID: 33272891 DOI: 10.1111/hepr.13576] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/30/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022]
Abstract
AIM This study aimed to evaluate the real-world efficacy and safety of 12-week sofosbuvir/velpatasvir (SOF/VEL) treatment for patients with decompensated liver cirrhosis caused by hepatitis C virus (HCV) infection. METHODS A total 72 of patients with Child-Pugh (CP) class B or C were enrolled. We evaluated the sustained virologic response at 12 weeks after the end of treatment (SVR12), adverse events (AEs), and changes in the liver function. RESULTS All participants had genotype 1 or 2 HCV infection. At baseline, the numbers of patients with CP class B and C were 59 and 13, respectively. The overall SVR12 rate was 95.8% (69/72); 94.9% (56/59) in CP class B and 100% (13/13) in CP class C. The serum albumin level, prothrombin time and ascites were significantly improved (P < 0.01); however, the serum bilirubin level and encephalopathy did not improve. Among patients who achieved SVR12, 75.0% showed an improvement in their CP score, while 5.9% showed a worsening. The presence of large portosystemic shunt (diameter ≥6 mm) and hyperbilirubinemia (≥2.0 mg/dL) were independent factors that interfered with the improvement in the CP score (P < 0.05). The most common AEs were encephalopathy (15.3%) and skin symptoms (7.9%). Two patients discontinued SOF/VEL due to AEs. CONCLUSIONS Treatment with SOF/VEL for 12 weeks was relatively safe and effective for patients with decompensated cirrhosis. An SVR provided an improvement of the liver function in the majority of patients. However, large portosystemic shunt and hyperbilirubinemia were independent factors that interfered with the improvement in the CP score.
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Affiliation(s)
- Yoshinari Takaoka
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan.,Department of Gastroenterology, Koga Red Cross Hospital, Koga, Japan
| | - Kouichi Miura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Naoki Morimoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Tadashi Ikegami
- Department of Gastroenterology, Ibaraki Medical Center, Tokyo Medical University, Ami, Japan
| | - Satoru Kakizaki
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ken Sato
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Hepatology, Heisei Hidaka Clinic, Takasaki, Japan
| | - Takashi Ueno
- Department of Internal Medicine, Isesaki Municipal Hospital, Isesaki, Japan
| | - Atsushi Naganuma
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Takashi Kosone
- Department of Gastroenterology and Hepatology, Kusunoki Hospital, Fujioka, Japan
| | - Hirotaka Arai
- Department of Gastroenterology, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Takeshi Hatanaka
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Toshiyuki Tahara
- Department of Gastroenterology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Shigeo Tano
- Department of Gastroenterology, Shin-Oyama City Hospital, Oyama, Japan
| | - Takaaki Ohtake
- Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Toshimitsu Murohisa
- Department of Gastroenterology, Ashikaga Red Cross Hospital, Ashikaga, Japan
| | - Masashi Namikawa
- Department of Internal Medicine, Kiryu Kosei General Hospital, Kiryu, Japan
| | - Takeharu Asano
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Toshiro Kamoshida
- Department of Gastroenterology, Hitachi General Hospital, Hitachi, Japan
| | - Katsuhiko Horiuchi
- Department of Gastroenterology, Gunma Chuo Hospital, Japan Community Health care Organization, Maebashi, Japan
| | - Takeshi Nihei
- Department of Gastroenterology, Mito Saiseikai General Hospital, Mito, Japan
| | - Atsuko Soeda
- Department of Gastroenterology, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Hidekazu Kurata
- Department of Gastroenterology, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Takeshi Fujieda
- Department of Internal Medicine, Kitaibaraki City Hospital, Kitaibaraki, Japan
| | - Toshiya Ohtake
- Department of Gastroenterology, Josai Hospital, Yuki, Japan
| | - Yukimura Fukaya
- Department of Internal Medicine, Nasu Minami Hospital, Nasukarasuyama, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | - Shunji Watanabe
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Norio Isoda
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
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