Efficacy of Interferon-Free Therapies for Chronic Hepatitis C: A Systematic Review of All Randomized Clinical Trials

Ferreira, Vinicíus Lins; Tonin, Fernanda S.; Jarek, Nayara A. Assis; Ramires, Yohanna; Pontarolo, Roberto

doi:10.1007/s40261-017-0521-4

Cited by 19 publications

(18 citation statements)

References 83 publications

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“…74 Two systematic reviews on interferon free treatment reported SVR12 in a range from 80% to 96%. 75,76 Relapse rates in community based models are comparable with tertiary based models. Risk of relapse after SVR achievement is reported as a challenge to treatment scale-up.…”

Section: Clinical Effectivenessmentioning

confidence: 85%

“…Based on the findings of this review, relapse rates in community settings ranged from 16.7% in a study on Peg‐IFN plus RBV based treatment to 2.2 in a study where patients received DAA regimens . In a systematic review on RCTs, 4.5% relapse was reported for interferon free therapy . Relapse is more highlighted in HIV infected patients due to their impaired immune system .…”

Section: Discussionmentioning

confidence: 98%

“…In a systematic review SVR12 among treatment naïve HCV genotype 1 in all DAA regimens without Peg‐IFN plus RBV ranged from 93% to 100% and in patients who received Peg‐IFN plus RBV was 48% . Two systematic reviews on interferon free treatment reported SVR12 in a range from 80% to 96% …”

Section: Discussionmentioning

confidence: 99%

“…34 In a systematic review on RCTs, 4.5% relapse was reported for interferon free therapy. 75 Relapse is more highlighted in HIV infected patients due to their impaired immune system. 77 Among included studies in this systematic review which reported relapse rate, in one study, 28 HIV infection was not mentioned as an exclusion criteria and in another study 34 24% of the patients were HIV positive.…”

Section: Clinical Effectivenessmentioning

confidence: 99%

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Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Pourmarzi

Hall

Hepworth

et al. 2019

Journal of Viral Hepatitis

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Summary Several community‐based models for treating hepatitis C virus (HCV) infection have been implemented to improve treatment accessibility and health outcomes. However, there is a lack of knowledge regarding how well these models achieve the desired goals. We conducted a mixed‐method systematic review of quantitative and qualitative evidence about clinical effectiveness, cost effectiveness and acceptability of community‐based HCV treatment models. Seventeen databases were researched for published and unpublished studies. Methodological quality was assessed using The Joanna Briggs Institute Critical Appraisal tools. Quantitative findings were synthesized in narrative form and qualitative findings were synthesized using meta‐synthesis. Forty‐two quantitative and six qualitative studies were included. No relevant cost effectiveness studies were found. Five categories of community‐based models were identified: telehealth, integration of HCV and addiction services, integration of HCV and HIV services, integration of HCV and primary care, and implementation by a home care and health care management company. The range of reported outcomes included; end of treatment response: 48.7% to 96%, serious side effects: 3.3% to 27.8%, sustained virological response: 22.3% to 95.5%, relapse: 2.2% to 16.7%, and treatment completion: 33.4% to 100%. Inconsistent measures of uptake and adherence were used; uptake ranged from 8.3% to 92%, and 68.4% to 100% of patients received ≥80% of prescribed doses. Patient reported experiences included trusted and supportive care providers, safe and trusted services, easily accessible care, and positive psychological and behavioural changes. The clinical effectiveness and acceptability reported from the included studies are similar to or better than reported outcomes from systematic reviews of studies in tertiary settings. Studies of the cost effectiveness of community‐based models for treating HCV are needed.

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Section: Clinical Effectivenessmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Effectivenessmentioning

confidence: 99%

See 2 more Smart Citations

Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Pourmarzi

Hall

Hepworth

et al. 2019

Journal of Viral Hepatitis

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“…Less attention has been paid to the treatment of patients with CKD stages 2 and 3. Different randomized clinical trials (RCTs) and real‐life cohorts have demonstrated the efficacy of different DAA combinations in CKD patients . Today, patient and viral characteristics have little or no impact on SVR rates which is high across nearly all patient populations, HCV genotypes, and treatment regimens.…”

Section: Current Regimens Available For Patients Ckdmentioning

confidence: 99%

Rationale for treating hepatitis C virus infection in patients with mild to moderate chronic kidney disease

Ridruejo

Mendizábal

Silva

2018

Hemodialysis International

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Hepatitis C virus infection (HCV) is highly prevalent in patients with chronic kidney disease (CKD) and kidney transplant recipients. Little information exists on treatment in patients with CKD stages 2 to 3, where CKD progression might be slowed by HCV treatment. These patients are not considered a high priority for HCV treatment in most international guidelines. Although some recently published guidelines propose universal treatment, others are still recommending it only in high priority groups. In this review, we evaluate current evidence of HCV infection impact on CKD progression, on cardiovascular and metabolic risk, and the benefits of HCV infection treatment to improve cardiovascular and metabolic outcomes. We made special focus on the benefits of HCV infection treatment in patients with stages 2 to 3 CKD to avoid CKD progression.

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Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model

et al. 2020

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IMPORTANCEAchievement of the World Health Organization (WHO) target of eliminating hepatitis C virus (HCV) by 2030 will require an increase in key services, including harm reduction, HCV screening, and HCV treatment initiatives in member countries. These data are not available for Canada but are important for informing a national HCV elimination strategy. OBJECTIVE To use a decision analytical model to explore the association of different treatment strategies with HCV epidemiology and HCV-associated mortality in Canada and to assess the levels of service increase needed to meet the WHO elimination targets by 2030. DESIGN, SETTING, AND PARTICIPANTS Study participants in this decision analytical model included individuals with hepatitis C virus infection in Canada. Five HCV treatment scenarios (optimistic, very aggressive, aggressive, gradual decrease, and rapid decrease) were applied using a previously validated Markov-type mathematical model. The optimistic and very aggressive treatment scenarios modeled a sustained annual treatment of 10 200 persons and 14 000 persons, respectively, from 2018 to 2030. The aggressive, gradual decrease, and rapid decrease scenarios assessed decreases in treatment uptake from 14 000 persons to 10 000 persons per year, 12 000 persons to 8500 persons per year, and 12 000 persons to 4500 persons per year, respectively, between 2018 and 2030. MAIN OUTCOMES AND MEASURES Hepatitis C virus prevalence and HCV-associated health outcomes were assessed for each of the 5 treatment scenarios with the goal of identifying strategies to achieve HCV elimination by 2030. RESULTS An estimated mean 180 142 persons (95% CI, 122 786-196 862 persons) in Canada had chronic HCV infection at the end of 2017. The optimistic and gradual decrease scenarios estimated a decrease in HCV prevalence from 180 142 persons to 37 246 persons and 37 721 persons, respectively, by 2030. Relative to 2015, this decrease in HCV prevalence was associated with 74%, 69%, and 69% reductions in the prevalence of decompensated cirrhosis, hepatocellular carcinoma, and liver-associated mortality, respectively, leading to HCV elimination by 2030. More aggressive treatment uptake (very aggressive scenario) could result in goal achievement up to 3 years earlier than 2030, although a rapid decrease in the initiation of treatment (rapid decrease scenario) would preclude Canada from reaching the HCV elimination goal by 2030. CONCLUSIONS AND RELEVANCEThe study findings suggest that Canada could meet the WHO goals for HCV elimination by 2030 by sustaining the current national HCV treatment rate during the next decade. This target will not be achieved if treatment uptake is allowed to decrease rapidly.

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Efficacy of Interferon-Free Therapies for Chronic Hepatitis C: A Systematic Review of All Randomized Clinical Trials

Cited by 19 publications

References 83 publications

Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Rationale for treating hepatitis C virus infection in patients with mild to moderate chronic kidney disease

Assessment of Treatment Strategies to Achieve Hepatitis C Elimination in Canada Using a Validated Model

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