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Effectiveness and safety of daclatasvir plus asunaprevir for hepatitis C virus genotype 1b: Systematic review and meta‐analysis
Author(s) -
Wang HuiLian,
Lu Xi,
Yang Xudong,
Xu Nan
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13587
Subject(s) - daclatasvir , medicine , adverse effect , hepatitis c virus , meta analysis , hepatitis c , cirrhosis , viral load , gastroenterology , genotype , virology , virus , ribavirin , biochemistry , gene , chemistry
Background and Aim Daclatasvir plus asunaprevir (DCV + ASV) has demonstrated potent antiviral activity in patients with hepatitis C virus (HCV) genotype 1b infection. A definite conclusion about efficacy and safety of DCV + ASV in patients with HCV genotype 1b is not available. A meta‐analysis was conducted to evaluate outcomes of all‐oral treatment with DCV + ASV in terms of sustained virological response at 12 (SVR 12 ) and 24 (SVR 24 ) weeks and adverse effects after the end of treatment. Methods PUBMED, MEDLINE, and EMBASE databases were searched in May 2016. The data were analyzed with Review Manager 5.3. Results Nine trials ( n = 1690) met entry criteria. SVR 12 was achieved by 89.9% of treatment‐naïve patients, 84.7% of interferon‐ineligible/intolerant patients, and 81.9% of nonresponder patients. Moreover, 89.0% of interferon‐ineligible/intolerant patients and 83.1% of nonresponder patients achieved SVR 24 . Baseline characteristics, including gender, race, advanced age, non‐CC IL28B genotype, and cirrhosis, did not appear to impact SVR rates. However, the rate of SVR 12 in all patients with viral load < 8 × 10 5 was higher than that of all those with viral load ≥ 8 × 10 5 (151/162 vs 625/753). Moreover, pre‐existing nonstructural protein 5A resistance‐associated variants (RAVs) were associated with virological failure during DCV + ASV therapy, resulting in the emergence of multiple RAVs. Treatment with DCV + ASV was well tolerated, with low incidences of serious adverse effects, discontinuations, and grade 3 or 4 laboratory abnormalities in all patients. Conclusions Daclatasvir plus asunaprevir provides a highly effective and well‐tolerated treatment option for patients with HCV genotype 1b. However, patients with nonstructural protein 5A RAVs at baseline should be assessed to optimize more potent direct antiviral agent therapies.