PIN7 REAL-WORLD EFFECTIVENESS OF DIRECT-ACTING ANTIVIRALS (DAA) IN YOUNG ADULT (18-25) AND ELDERLY (80+) POPULATIONS WITH HEPATITIS C (HCV)

Abstract

To compare young adult (18-25) and elderly (80+) populations with HCV by patient, treatment, and disease characteristics and effectiveness of DAA treatment. Data were collected using Trio Health disease management program and are specific to patients initiating anti-HCV therapy between October 2015 to February 2019 with ≥9 months follow up and serviced by Trio Specialty Pharmacy Partners. Univariate analyses were conducted using chi-square test. Of 566 qualified patients, 229 (40%) were young adults and 337 (60%) elderly. The young group was significantly different (all p<0.001) from the elderly group in females (52% vs 67%), commercial insurance coverage (46% vs 16%), baseline eGFR ≥90 ml/min (95% vs 17%), APRI ≤0.5 (51% vs 27%), APRI >1.5 (10% vs. 22%), HCV viral load >6M (11% vs 18%), genotype (GT2 8% vs 22%, GT3 26% vs 3%, GT4-6 2% vs 11%), depression (23% vs 7%), diabetes (1% vs. 19%), hyperlipidemia (0% vs. 10%), hypertension (3% vs 53%), and in being treatment-naïve (98% vs 86%). DAA regimens were different between young and elderly groups: LDV-SOF 42% vs 54%, GLE-PIB 18% vs 8%, SOF-VEL 27% vs 20%,and EBR-GZR 5% vs 10% (all p<0.001). DAA effectiveness was lower in the young group (intent to treat sustained virologic response at 12 weeks [SVR] 78% vs 86% elderly, p=0.009) as a result of more lost to follow up (15% vs 4% elderly, p<0.001); discontinuation, death, and virologic failure were not significantly different between the groups. Despite more severe disease and increased comorbidity burden, the elderly population realized higher DAA effectiveness compared to the young population. Patient engagement in young adults with HCV is suboptimal and should be a focus of care.