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."