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Battling hepatitis C in the elderly

July 26, 2016
by Pamela Tabar, Editor-in-Chief
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The U.S. Food and Drug Administration (FDA) has approved a new drug application for a medication to treat hepatitis C Genotype 1, the most common form of the virus. But treating hepatitis in seniors can be tricky, thanks to weakened immune systems, comorbidities and medication interactions.

Viekira XR, manufactured by AbbVie, is a direct-acting antiviral in a three-tablet pack taken once per day. It can be used with or without ribavirin, the most common drug used to treat Genotype 1a. Phase 3 clinical trials showed 100 percent sustained response for those with Genotype 1b and 95 percent for Genotype 1a. In most cases, the treatment period was 12-24 weeks, the company notes.

Of the six major genotypes of the virus, Genotypes 1 and 2 are by far the most common in North America. The contagious disease can cause liver inflammation, tissue damage and increased risk of liver cancer. Older adults with the disease have higher risks of cirrhosis and other types of liver damage.

Plenty of studies have been done globally for younger adults, but seniors have different risk factors and comorbidities, notes an article in Clinical Gastroenterology and Hepatology journal. “Although the safety and efficacy of hepatitis C therapies have been extensively studied in patients between ages of 18 and 65, patients who are over 65 still remain an understudied and difficult to treat population,” the authors write.

Direct-acting antivirals can be effective treatments, but can cause significant side-effects in older people. Diligent attention to medication reviews to avoid drug interactions and polypharmacy, tracking of liver functions and frequent monitoring of medication compliance are all important, noted presenters at the March 2016 International Conference on Viral Hepatitis, held in San Francisco.

In a recent study tracking 121 patients over 65 who sought treatment for Hepatitis C between 2012 and 2015, more than 85 percent were on multiple medications and many required adjustments to prescriptions, said Dr. Berta Pernas, a session presenter from Corunna University Hospital in Spain, in conference coverage provided by Medscape. "We need more data about these new treatments in the elderly," Pernas said. "I think we can treat these patients, but caution for interactions and adverse events is required.”

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