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 Andriulli and colleagues assessed the effectiveness of the interferon-free regimens in Child C cirrhotic patients with HCV infection.
The team conducted a systematic Medline 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.
|The weighted mean sustained virological response was 75%|
|Alimentary Pharmacology & Therapeutics|
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 researchers found that the weighted mean sustained virological response was 75%.
The team observed that neither duration of treatment, nor addition of ribavirin influenced these rates.
The research team noted that the weighted sustained virological response was 65% after sofosbuvir/simeprevir, 76% after sofosbuvir/daclatasvir and 83% 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% of patients, and an improvement of ≥2 points on the model for end-stage liver disease (MELD) score in 61% of patients.
Dr Andriulli's team concludes, "The improvement in MELD scores strongly suggests HCV-positive patients with Child C cirrhosis should be treated with these agents."