Systematic review: interferon‐free regimens for patients with HCV‐related Child C cirrhosis. Issue 9 (6th March 2017)

• Record Type: Journal Article
• 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.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 45:Issue 9(2017)
• Page Start: 1193
• Page End: 1200
• Publication Date: 2017-03-06
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.14017
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: 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. Abstract : Linked Content This article is linked to Braillon, Andriulli et al, and Rezaee‐Zavareh and Alavian papers. To view these articles visithttps://doi.org/10.1111/apt.14184, https://doi.org/10.1111/apt.14099 andhttps://doi.org/10.1111/apt.14083 .