Direct-acting antivirals are effective in the treatment of chronic hepatitis C virus (HCV) infection, although results for patients infected with genotype 3 are suboptimal.
There are several regimens available, however, direct comparisons have not been made and are unlikely to occur.
Dr Joost Drenth and colleagues from the Netherlands identified the most effective direct-acting antivirals regimen for patients infected with HCV genotype 3, and assessed the role of ribavirin.
The researchers conducted a systematic search of PubMed, Embase, and Web of Science databases through 2016.
|Ribavirin increases efficacy in patients with and without cirrhosis|
|Clinical Gastroenterology & Hepatology|
The team performed a Bayesian network meta-analysis using a random-effects model to indirectly compare regimens in patients with and without cirrhosis.
The researchers identified 2167 articles, of which 27 studies comprizing 3415 patients were included.
Among patients without cirrhosis, the team found that the greatest rates of sustained virilogic response were estimated for those receiving sofosbuvir + velpatasvir with ribavirin; and without ribavirin; sofosbuvir + daclatasvir + ribavirin; and sofosbuvir + peginterferon + ribavirin, all for 12 weeks.
Among patients with cirrhosis, the highest rates of sustained virologic response were estimated for those receiving sofosbuvir + velpatasvir for 24 weeks; sofosbuvir + daclatasvir + ribavirin for 24 weeks; and sofosbuvir + velpatasvir + ribavirin for 12 weeks.
The team observed that ribavirin increases efficacy in patients with and without cirrhosis.
Dr Drenth's team concludes, "An indirect comparison of DAA-based treatments, using Bayesian network meta-analysis, found regimens containing sofosbuvir and velpatasvir to be the best option for patients with HCV genotype 3 infection."
"Our analyses indicated that ribavirin significantly increases sustained virilogical response rates and should be considered if tolerated."