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Hepatology
Meta-analysis
Systematic review and meta-analysis: real-world effectiveness of direct-acting antiviral therapies in chronic hepatitis C genotype 3 in Asia
  1. Bin Wei1,
  2. Fanpu Ji1,2,3,
  3. Yee Hui Yeo1,
  4. Eiichi Ogawa1,4,
  5. Christopher D Stave5,
  6. Shuangsuo Dang2,
  7. Zongfang Li3,6,
  8. Norihiro Furusyo4,
  9. Ramsey C Cheung1,7,
  10. Mindie H Nguyen7
  1. 1Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
  2. 2Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
  3. 3Shaanxi Provincial Clinical Research Center for Hepatic & Splenic Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
  4. 4Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
  5. 5Lane Library, School of Medicine, Stanford University, Stanford, California, USA
  6. 6National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, People’s Republic of China
  7. 7Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
  1. Correspondence to Dr Mindie H Nguyen; mindiehn{at}stanford.edu

Abstract

Background Genotype 3 (GT3) is a common chronic hepatitis C (CHC) genotype in Asia. Direct-acting antiviral (DAA) regimens have high cure rates, but real-world results are limited for Asia.

Aim To determine the real-world effectiveness of DAAs for patients with CHC GT3 in Asia.

Methods A systematic search was performed in PubMed (including MEDLINE), Embase, and selected international meeting abstract repositories. Eligible studies were postmarketing observational studies from Asia with the primary outcome of sustained virological response 12 weeks after completion of treatment (SVR12).

Results A total of 15 studies with 4230 patients yielded a pooled SVR12 of 92.7%. High heterogeneity (I2=93.2%, P<0.0001) was noted. In subgroup analyses, patients with cirrhosis had 10.9% lower SVR12 than non-cirrhotic patients (88.6% vs 98.9%; P<0.0001) and contributed 69.5% of the heterogeneity. Prior treatment failure did not reduce the pooled SVR12 (treatment-naïve: 94.6%, 95% CI 91.3% to 96.7% vs treatment-experienced: 94.0%, 95% CI 77.5% to 98.6%; P=0.89). Twenty-four weeks of sofosbuvir+ribavirin dual therapy was the most commonly used regimen which led to similar SVR12 (OR=1.1, P=0.73) but lower adverse event rate than 12 weeks of sofosbuvir+ribavirin+pegylated interferon triple therapy.

Conclusion Sofosbuvir+ribavirin for 24 weeks is the most widely used and generally well-tolerated DAA therapy in Asia. However, its effectiveness is not optimal in GT3 patients with cirrhosis.

  • hepatitis C
  • liver cirrhosis
  • genotype
  • adverse drug reactions

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgast-2018-000209

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    Footnotes

    • BW and FJ contributed equally.

    • Contributors BW and FJ: study design, data collection, data analysis, data interpretation and drafting of the manuscript. YHY, EO, CDS, RCC: study design, data collection, data interpretation and critical revision of the manuscript. SD, ZL, NF: data collection, data interpretation and critical review of the paper. MHN: study conception, study design, data collection, data analysis, data interpretation, drafting of the manuscript and supervision of the study. All authors read and approved the final version of manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests NF: grant/research support: MSD, Gilead Sciences, Bristol-Myers Squibb and Janssen Pharmaceuticals; speaker’s bureau: Gilead Sciences, MSD, Bristol Myers and Janssen Pharmaceuticals; advisory board: Gilead Sciences, AbbVie and Bristol-Myers Squibb. MHN: grant/research support: BK Kee Foundation, Asian Health Foundation, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals, National Cancer Institute, Pfizer Pharmaceutical; advisory board member or consultant: Dynavax Laboratories, Gilead Sciences, Intercept Pharmaceuticals, Alnylam Pharmaceutical, Bristol-Myers Squibb, Novartis Pharmaceutical and Janssen Pharmaceuticals.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Presented at This study has been presented as poster at the 2017 AASLD and 2018 APASL conferences.