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Systematic review with meta‐analysis: comparison between therapeutic regimens for paediatric chronic hepatitis C
Author(s) -
El Sherbini A.,
Mostafa S.,
Ali E.
Publication year - 2015
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13221
Subject(s) - ribavirin , medicine , pegylated interferon , regimen , adverse effect , hepatitis c , gastroenterology , interferon , odds ratio , confidence interval , hepatitis c virus , genotype , alpha interferon , immunology , virus , biology , biochemistry , gene
Summary Background To decide when and how to treat children with chronic hepatitis C is an ongoing debate. Aim To compare the outcomes of therapy for children with chronic hepatitis C. Methods An electronic database assessed clinical trials with sustained virological response rates specified by genotype. The data were extracted according to the therapeutic regimen; interferonα±ribavirin and pegylated interferonα±ribavirin. Results The search sourced 23 peer‐reviewed articles which enrolled 934 cases, aged 2–19 years. Sustained virological response rates were significantly higher with the addition of ribavirin to either interferonα or pegylated nterferonα vs. their monotherapies for genotypes 1,2&3 with crude and weighted estimates. The weighted estimate indicated higher sustained virological response rates for those treated with pegylated interferonα+ribavirin vs. interferonα+ribavirin for genotype 1 (50% vs. 40%) and genotypes 2&3 (90% vs. 84%), (odds ratio 1.5, 95% confidence interval 1.2–1.8, and 1.8, 1.2–2.9 respectively). Cases with genotype 4 treated with pegylated interferonα+ribavirin had a lower sustained virological response (41%) vs. genotype 1 (1.4, 1.2–1.8), and vs. genotypes 2&3 (13.5, 10.3–17.9). Some adverse events were significantly higher among cases treated with pegylated interferonα+ribavirin vs. interferonα+ribavirin. Conclusions Despite the superiority of pegylated interferonα+ribavirin to interferonα+ribavirin for the treatment of chronic hepatitis C among children, the significant higher adverse events along with the modest outcome for genotypes 1&4 render that regimen a suboptimal therapy. These data indicated the need for the future comparison with clinical trials of direct anti‐viral drugs for children with chronic hepatitis C.