The impact of antihyperlipidemic drugs on the viral load of patients with chronic hepatitis C infection: a meta‐analysis

Abstract

Several studies investigating the role of statins and fibrates in chronic hepatitis C virus (HCV) infection offered so far conflicting evidence regarding the antiviral potency of these medications, whereas combination of these drugs with pegylated interferon and ribavirin improved in some trials therapeutic outcome. We conducted a literature search to identify trials that included monoinfected HCV patients, treated with statins or fibrates as monotherapy with the primary end point of our meta-analysis being the quantitative change of HCV-RNA induced by these medications. Logarithmic changes of the viral load (ΔlogVL) and confidence intervals (CIs) were calculated according to the DerSimonian-Laird estimate. Statistical heterogeneity was assessed with the I² statistic. We identified eight observational studies that evaluated the potency of bezafibrate and different statins as monotherapy to induce a significant reduction of HCV-RNA in HCV-monoinfected patients (n = 281). Overall, a significant reduction of viral load with mean 0.19 [log10 IU/mL] (95%-confidence interval, (CI) 0.11-0.28) could be observed when antihyperlipidemic medications were administered. Bezafibrate featured the highest antiviral efficacy (0.45 log10 reduction, 95%-CI, 0.17-0.72) among all medications and fluvastatin (0.20 log10 reduction, 95%-CI, 0.09-0.31) among all statins tested. Based on meta-analysis, fibrates and statins induce a reduction of HCV viral load. We suggest that the addition of statins and fibrates to antiviral regimes, especially in HCV patients with concomitant dyslipidemia, could beside the established reduction of cardiovascular risk increase the potency of antiviral therapy.

Host-Targeting Agents to Prevent and Cure Hepatitis C Virus Infection

“…HNF4α down-regulation by bezafibrate dramatically reduced HCV secretion [ 235 ]. In line with this study, a meta-analysis showed that bezafibrate is associated with a reduction of viral load in chronically HCV-infected patients [ 168 ]. Moreover, in association with IFN and ribavirin, bezafibrate has been reported to reduce serum HCV RNA titers and to improve liver dysfunction [ 37 ].…”

“…Notably, not all HMGCoA reductase inhibitors affect HCV replication, suggesting the existence of a different structure-activity relationship between the anti-HMGCoA reductase activity and the antiviral activity [ 166 ]. Fluvastatin is a statin that has been reported to increase the efficacy of IFN-based treatment in chronic HCV-infected patients [ 30 , 31 , 167 , 168 ]. Recent in vitro studies have provided novel insights into the mechanism of action of fluvastatin.…”

The hyperlipidaemic drug fenofibrate significantly reduces infection by SARS-CoV-2 in cell culture models

“…These properties may reduce or prevent hypercoagulability seen in the late stage of disease in many SARS-CoV-2 patients (34). A metanalysis has also suggested fenofibrate may be useful in the treatment of Hepatitis C infection (35). Lastly, we note a preprint from the group of Nahmias that has also suggested fenofibrate may have clinical effects against SARS-CoV-2 infection which depends on the PPARα mediated alterations in host cell metabolism (36).…”

No Time to Waste: Real-World Repurposing of Generic Drugs as a Multifaceted Strategy Against COVID-19

“…The antiviral potency of bezafibrate was confirmed in both Asian and European study populations. Interestingly, the significant clinical effect was found despite the failure of in vitro studies to demonstrate a significant effect [82].…”