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News

High cure rate with oral direct-acting antiviral treatment for Hep C virus genotype 1

March's edition of the Alimentary Pharmacology and Therapeutics explores the effectiveness and tolerability of interferon-free direct-acting antiviral regimens for
chronic hepatitis C genotype 1 in Asia. 

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Direct-acting antiviral regimens have shown high efficacy and tolerability for patients with hepatitis C virus genotype 1/1b in clinical trials.

However, robust real-world evidence of interferon-free direct-acting antiviral treatment for hepatitis C virus genotype 1-infected patients in Asia is still lacking.

To systematically review and meta-analyse the effectiveness and tolerability of interferon-free direct-acting antiviral therapy for hepatitis C virus genotype 1 infection in Asia.

Dr Nguyen and colleagues from California, USA included studies that enrolled adult patients with hepatitis C virus genotype 1 infection in routine clinical practice in Asia, using interferon-free direct-acting antiviral regimens, and reported sustained virological response after 12/24 weeks end-of-treatment by 2017. 


Patients with renal dysfunction treated with daclatasvir/asunaprevir had a higher sustained virological response rate 
Alimentary Pharmacology & Therapeutics
The pooled sustained virological response rates were computed with a random-effects model.

Subgroup analysis and meta-regression as previously registered in PROSPERO were performed to determine how pre-planned variables might have affected the pooled estimates.

The researchers included 41 studies from 8 countries and regions, comprizing of 8574 individuals.

Baseline cirrhosis but not prior treatment history and age, attenuated the effectiveness of both regimens.

Baseline resistance associated substitutions severely attenuated sustained virological response of daclatasvir/asunaprevir and only minimally with  ledipasvir/sofosbuvir ± ribavirin.

The team discovered that patients with renal dysfunction treated with daclatasvir/asunaprevir showed a higher sustained virological response rate.

Patients with hepatocellular carcinoma ledipasvir/sofosbuvir ± ribavirin achieved a lower sustained virological response than those without hepatocellular carcinoma.

Dr Nguyen's team comments, "All oral direct-acting antiviral treatment of hepatitis C virus genotype 1 resulted in high cure rates in Asian patients in routine clinical practice setting including elderly patients and those with end-stage renal disease."

Aliment Pharmacol Ther 2018: 47(5): 547–700
15 February 2018

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