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 19 January 2018

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News

Interferon-free regimens for patients with HCV-related Child C cirrhosis

The most recent issue of the Alimentary Pharmacology & Therapeutics assessed the effectiveness of the interferon-free regimens in Child C cirrhotic patients with HCV infection.

News image

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.

Dr Guarino and colleagues assess the effectiveness of the interferon-free regimens in Child C cirrhotic patients with HCV infection.

The team performed a systematic Medline search was 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. 

The weighted mean sustained virological response was 75%
Alimentary Pharmacology & Therapeutics
Extracted data were evaluated using a meta-analysis to calculate a weighted response rate.

The team retained 7 full-text records, and 2 conference abstracts 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 was 75%. 

Neither duration of treatment, nor addition of ribavirin influenced these rates. 

The researchers found that the weighted sustained virological response was 65% after sofosbuvir/simeprevir, 76% after sofosbuvir/daclatasvir, and 83% after sofosbuvir/ledipasvir. 

The team noted that 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% of patients, and an improvement of ≥2 points on the model for end-stage liver disease (MELD) score in 61% of patients.

Dr Guarino's team comments, "The improvement in MELD scores strongly suggests HCV-positive patients with Child C cirrhosis should be treated with these agents."

Aliment Pharmacol Ther 2017: 45(9): 1193–1200 
10 April 2017

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