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Effectiveness of antiviral treatment for Hepatitis C virus infection in adults

This month's publication of the Annals of Internal Medicine compares the effectiveness of antiviral treatment for Hepatitis C virus infection in adults.

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Dr Roger Chou and colleagues compared benefits and harms of antiviral regimens for chronic HCV infection in treatment-naive adults.

The team searched for English-language literature from MEDLINE, the Cochrane Library Database, Embase, Scopus, PsychINFO, and clinical trial registries.

The research team identified randomized trials of antiviral treatments, and cohort studies examining associations between sustained virologic response after therapy and clinical outcomes.

Several investigators abstracted study details and quality by using predefined criteria.

The researchers noted that no trial evaluated effectiveness of treatment on long-term clinical outcomes.

PEG-interferon alfa-2b plus ribavirin was associated with a lower sustained virologic response
Annals of Internal Medicine

Dual therapy with pegylated interferon alfa-2b plus ribavirin was associated with a lower likelihood of sustained virologic response than was pegylated interferon alfa-2a plus ribavirin.

For genotype 2 or 3 infection, dual therapy for 12 to 16 weeks was associated with a lower likelihood of sustained virologic response than was therapy for 24 weeks, and lower doses of pegylated interferon alfa-2b were less effective than standard doses.

The doctors found that for genotype 1 infection, fair-quality trials reported that triple therapy with pegylated interferon, ribavirin, and either boceprevir or telaprevir was associated with a higher likelihood of sustained virologic response than was dual therapy.

Compared with dual therapy, boceprevir triple therapy increased risk for hematologic adverse events, and telaprevir triple therapy increased risk for anemia and rash.

The research team noted that a large well-designed cohort study and 18 smaller cohort studies found that an sustained virologic response after antiviral therapy was associated with lower risk for all-cause mortality than was no sustained virologic response.

Trials involved highly selected populations.

The team found that observational studies did not always adequately control for confounders.

Dr Chou's team commented, "Sustained virologic response rates for genotype 1 infection are higher with triple therapy that includes a protease inhibitor than with standard dual therapy."

"A sustained virologic response after antiviral therapy appears associated with improved clinical outcomes." 

Ann Intern Med 2013; 158(2): 114-123
28 January 2013

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