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- Title
Systematic review: interferon-free regimens for patients with HCV-related Child C cirrhosis.
- Authors
Guarino, M.; Morisco, F.; Valvano, M. R.; Ippolito, A. M.; Librandi, M.; Andriulli, N.; Greco, M.; Amoruso, A.; Iacobellis, A.; Niro, G.; Caporaso, N.; Andriulli, A.
- Abstract
Background It is unclear whether the efficacy and long-term outcome of treating patients with hepatitis C virus (HCV)-positive cirrhosis with the new protease inhibitors will extend to those with Child C cirrhosis. Aim To assess the effectiveness of the interferon-free regimens in Child C cirrhotic patients with HCV infection. Methods A systematic Medline search was conducted to retrieve studies describing the treatment of Child C patients with direct-acting agents. Citations from identified studies were cross-referenced and abstracts from European Association for the Study of the Liver ( EASL) and American Association for the Study of Liver Disease ( AASLD) meetings were checked. Extracted data were evaluated using a meta-analysis to calculate a weighted response rate. Results Seven full-text records and two conference abstracts were retained for analysis from the 649 records identified. Data from an Italian real-life trial were also interrogated. Information on treatment outcome was available for 228 of the 240 Child C patients evaluated in the 10 trials. Overall, the weighted mean sustained virological response (SVR12) was 74.9% (95% CI: 65.6-82.4%). Neither duration of treatment (24 or 12 weeks), nor addition of ribavirin influenced these rates. The weighted SVR12 was 65.4% (95% CI: 46.8-80.2) after sofosbuvir/simeprevir, 76.0% (95% CI: 54.4-89.3%) after sofosbuvir/daclatasvir and 83.0% (95% CI: 73.4-89.6) after sofosbuvir/ledipasvir. Some studies did not provide information on the rate of post-treatment relapse or functional improvement. However, in those studies that did provide such data, a relapse was documented in 12.1% of patients and an improvement of ≥2 points on the model for end-stage liver disease ( MELD) score in 61.1% of patients. Conclusion The improvement in MELD scores strongly suggests HCV-positive patients with Child C cirrhosis should be treated with these agents.
- Subjects
HEALTH outcome assessment; TREATMENT effectiveness; CHRONIC hepatitis C; INTERFERONS; CIRRHOSIS of the liver; PATIENTS
- Publication
Alimentary Pharmacology & Therapeutics, 2017, Vol 45, Issue 9, p1193
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.14017