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 19 February 2018

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Oral direct-acting antivirals for HCV infection

A study in this month's issue of the Annals of Internal Medicine summarizes published literature on the efficacy and safety of oral direct-acting antivirals for treatment of persons with chronic HCV infection.

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Rapid improvements in hepatitis C virus (HCV) therapy have led to the approval of multiple oral direct-acting antiviral regimens by the U.S. Food and Drug Administration (FDA) for treatment of chronic HCV infection.

Dr Mark Sulkowski and colleagues from Maryland, USA summarizes published literature on the efficacy and safety of oral direct-acting antivirals for treatment of persons with chronic HCV infection.

The team searched MEDLINE and EMBASE from inception through 2016.

The researchers identified 42 English-language studies from controlled and single-group registered clinical trials of adults with HCV infection that evaluated at least 8 weeks of an FDA-approved interferon-free HCV regimen that included at least 2 direct-acting antivirals.

There were 2 investigators that abstracted data on study design, patient characteristics, and virologic and safety outcomes sequentially and assessed quality independently.

Regimens that included ribavirin had more mild or moderate adverse events than those without
Annals of Internal Medicine
The team observed that 6 DAA regimens showed high sustained virologic response rates in patients with HCV genotype 1 infection without cirrhosis, including those with HIV co-infection. 

Effective treatments for HCV genotype 3 infection are limited. 

The researchers noted that patients with hepatic decompensation, particularly those with Child–Turcotte–Pugh class C disease, had lower sustained virologic response rates than other populations. 

The addition of ribavirin was associated with increased sustained virologic response rates for certain direct-acting antiviral regimens and patient groups. 

The research team found that overall rates of serious adverse events, and treatment discontinuation were low.

Regimens that included ribavirin had more mild or moderate adverse events than those without.

Dr Sulkowski's team comments, "Multiple oral direct-acting antiviral regimens show high rates of safety, tolerability, and efficacy for treatment of HCV genotype 1 infection, particularly among persons without cirrhosis."

Ann Int Med 2017: 166(9)
03 May 2017

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