Effectiveness of direct-acting agents for chronic hepatitis C treatment in South America: A systematic review and meta-analysis

Elio C. Castro Filho; Juliana Piedade; Rodolfo Castro; Paula M. Luz; Flavia Fernandes; Beatriz Grinsztejn; Valdilea G. Veloso; Gustavo Henrique Pereira; Hugo Perazzo

doi:10.1111/jvh.13364

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Effectiveness of direct-acting agents for chronic hepatitis C treatment in South America: A systematic review and meta-analysis

Journal article

Peer reviewed

Effectiveness of direct-acting agents for chronic hepatitis C treatment in South America: A systematic review and meta-analysis

Elio C. Castro Filho, Juliana Piedade, Rodolfo Castro, Paula M. Luz, Flavia Fernandes, Beatriz Grinsztejn, Valdilea G. Veloso, Gustavo Henrique Pereira and Hugo Perazzo

Journal of viral hepatitis, Vol.27(12), pp.1396-1407

12/01/2020

DOI: 10.1111/jvh.13364

PMID: 32706518

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Abstract

The effectiveness of direct-acting agents (DAAs) for hepatitis C treatment in limited-resource settings remains unclear. We estimated the pooled sustained virological response rates of DAA therapy in South America. We searched online databases for studies that reported 12-week sustained virological response (SVR12) to hepatitis C virus (HCV) treatment in individuals living in South America. Pooled SVR12 in intention-to-treat (ITT) and per-protocol were estimated. Additionally, using all studies with available data, the pooled relative risk (RR) of SVR12 using a random-effects model (DerSimonian-Laird) was estimated to compare effectiveness of DAAs in patients with or without cirrhosis, HIV co-infection or previous HCV therapy. Heterogeneity was assessed using theI(2)statistics. We identified 20 studies [14 manuscripts and 6 conference abstracts] comprising 7393 individuals from five countries [Brazil (n = 11), Argentina (n = 4), Chile (n = 1), Colombia (n = 1) and Peru (n = 1)] and two South-American collaborations. The pooled overall SVR12 rates [95% confidence interval (CI)] were 92.6% [90.2-94.7] and 95.5% [94.3-96.6] by ITT (11 studies; n = 4,153;I-2 = 84.2%) and per-protocol analysis (15 studies; n = 4,833;I-2 = 64.5%), respectively. The RR of SVR12 was similar in patients with or without HIV co-infection [4 studies; RR = 1.03 (0.99-1.07)] and those naive compared with treatment experimented-individuals [9 studies; RR = 1.01 (1.00-1.03)], but significantly higher in patients without cirrhosis compared with those with cirrhosis [11 studies; RR = 1.04 (1.02-1.05),P < .001]. DAAs are highly effective for HCV treatment in South America. The use of DAAs should be considered in limited-resource settings to decrease the burden of liver disease in HCV-infected patients. PROSPERO[CRD 42019134603].

Gastroenterology & Hepatology

Infectious Diseases

Life Sciences & Biomedicine

Science & Technology

Virology

Details

Title: Subtitle: Effectiveness of direct-acting agents for chronic hepatitis C treatment in South America: A systematic review and meta-analysis
Creators: Elio C. Castro Filho - Fundação Oswaldo Cruz
Juliana Piedade - Hospital Geral de Bonsucesso
Rodolfo Castro - Instituto de Saúde
Paula M. Luz - Fundação Oswaldo Cruz
Flavia Fernandes - Hospital Geral de Bonsucesso
Beatriz Grinsztejn - Fundação Oswaldo Cruz
Valdilea G. Veloso - Fundação Oswaldo Cruz
Gustavo Henrique Pereira - Hospital Geral de Bonsucesso
Hugo Perazzo - Fundação Oswaldo Cruz
Resource Type: Journal article
Publication Details: Journal of viral hepatitis, Vol.27(12), pp.1396-1407
DOI: 10.1111/jvh.13364
PMID: 32706518
ISSN: 1352-0504
eISSN: 1365-2893
Publisher: Wiley
Number of pages: 12
Grant note: 001 / Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior; Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES) PJP INI-003-FIO-19-2-5 / Fundacao Oswaldo Cruz University Estacio de Sa
Language: English
Date published: 12/01/2020
Academic Unit: Internal Medicine
Record Identifier: 9985221246902771

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