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Meta‐analysis: re‐treatment of genotype I hepatitis C nonresponders and relapsers after failing interferon and ribavirin combination therapy
Author(s) -
Singal A. G.,
Waljee A. K.,
Shiffman M.,
Bacon B. R.,
Schoenfeld P. S.
Publication year - 2010
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/j.1365-2036.2010.04427.x
Subject(s) - ribavirin , medicine , combination therapy , gastroenterology , pegylated interferon , hepatitis c , randomized controlled trial , hepatitis c virus , population , alpha interferon , immunology , interferon , virus , environmental health
Aliment Pharmacol Ther 2010; 32: 969–983 Summary Background The efficacy of re‐treating genotype I hepatitis C virus (HCV) patients who failed combination therapy with interferon/pegylated interferon (PEG‐IFN) and ribavirin remains unclear. Aims To quantify sustained virological response (SVR) rates with different re‐treatment regimens through meta‐analysis of randomized controlled trials (RCTs). Methods Randomized controlled trials of genotype I HCV treatment failure patients that compared currently available re‐treatment regimens were selected. Two investigators independently extracted data on patient population, methods and results. The pooled relative risk of SVR for treatment regimens was computed using a random effects model. Results Eighteen RCTs were included. In nonresponders to standard interferon/ribavirin, re‐treatment with high‐dose PEG‐IFN combination therapy improved SVR compared with standard PEG‐IFN combination therapy (RR = 1.49; 95% CI: 1.09–2.04), but SVR rates did not exceed 18% in most studies. In relapsers to standard interferon/ribavirin, re‐treatment with high‐dose PEG‐IFN or prolonged CIFN improved SVR (RR = 1.57; 95% CI: 1.16–2.14) and achieved SVR rates of 43–69%. Conclusions In genotype I HCV treatment failure patients who received combination therapy, re‐treatment with high‐dose PEG‐IFN combination therapy is superior to re‐treatment with standard combination therapy, although SVR rates are variable for nonresponders (≤18%) and relapsers (43–69%). Re‐treatment may be appropriate for select patients, especially relapsers and individuals with bridging fibrosis or compensated cirrhosis.