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Meta‐analysis: antiviral treatment for hepatitis D
Author(s) -
Triantos C.,
Kalafateli M.,
Nikolopoulou V.,
Burroughs A.
Publication year - 2012
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.1365-2036.2012.04993.x
Subject(s) - medicine , virology , hepatitis , immunology
Summary Background There is no satisfactory treatment for patients with hepatitis D ( HDV ). Aim To evaluate treatment for HDV using meta‐analysis. Methods M edline, S copus, C ochrane L ibrary and ISI W eb of K nowledge searches using the textwords ‘Hepatitis D’, ‘therapy’, “interferon”, “peginterferon”, “pegylated interferon”, “lamivudine”, “pegifn”, “ifn” and “Hepatitis D”, and abstracts from major Gastroenterology / Liver meetings. Endpoints: end of treatment biochemical (biochemical EOT ) and virological response (virological EOT ), end of follow‐up virological response ( EOFUP VR ), histological improvement and intrahepatic HDA g clearance. Results We included randomised clinical trials ( RCT s) comparing Group A: interferon‐A ( IFN a) vs. no treatment (three RCT s, n ; = ;137 patients), Group B: low dose vs. high dose IFN a (two RCT s, n ; = ;60), Group C: IFN a ;+ ;lamivudine vs. IFN a (two RCT s, n ; = ;48) and Group D: pegylated IFN a ( PEG ‐ IFN a) vs. other medications (two RCT s, n ; = ;157). Group A. IFN a was better for biochemical EOT [ OR , 0.11 (95% CI , 0.04–0.2)] and virological EOT [ OR , 0.08 (95% CI , 0.03–0.2)], but not for EOFUP VR . Group B. High dose IFN a was better for biochemical EOT [ OR , 0.24 (95% CI ,0.08–0.73)] and virological EOT [ OR , 0.27 (95% CI , 0.1–0.74)]. Group C. There was a trend favouring histological improvement [ OR , 2.9 (95% CI , 0.6–13.4)]. Group D. PEG ‐ IFN a was better for virological EOT [ OR , 0.419 (95% CI , 0.18–0.974)], EOFUP VR [ OR , 0.404 (95% CI , 0.189–0.866)] and improvement in necroinflammatory activity [ OR , 0.308 (95% CI , 0.129–0.732)]. Conclusions Long‐term suppression of HDV RNA by IFN a is not maintained despite an end of treatment response; adding lamivudine is not beneficial. PEG ‐ IFN a is superior to other medications with respect to EOT and EOFUP . New RCT s should test combinations of PEG ‐ IFN a and newest antivirals.