A systematic review with meta-analysis: Is ribavirin necessary in sofosbuvir-based direct-acting antiviral therapies for patients with HCV recurrence after liver transplantation?

Abstract

With the appearance of direct-acting antiviral agents (DAAs), sofosbuvir (SOF)-based DAAs are recommended for patients with hepatitis C virus (HCV) recurrence after liver transplantation (LT). Whether ribavirin (RBV) is needed by patients after LT in combination with SOF-based DAAs remains to be determined. This meta-analysis was conducted to evaluate the necessity of RBV with SOF-based DAAs for post-LT patients. Methods: PubMed, Web of Science, Cochrane Library and EMBASE databases were systematically searched for eligible studies from the databases' inceptions until November 2018. We accepted the studies that included HCV recurrence in post-LT patients who were treated with SOF-based DAAs AE RBV, and evaluated the rate of sustained virological response 12 weeks (SVR12) after the end of treatment. Results: Twelve studies, comprising a total of 1466 LT recipients, were included in this study. The pooled SVR12 of these patients was 91% (95% CI: 84% to 95%). There was no statistical difference of SVR12 in the patients treated with SOF-based DAAs + RBV versus -RBV group (risk ratio [RR] = 0.97; 95% CI: 0.92 to 1.03; P = 0.35) by different therapy duration (P = 0.26), with different targets of DAAs (P = 0.13) and in different regions (P = 0.34) but a tendency for a higher incidence of anemia in the +RBV group than in the ÀRBV group (RR = 5.18; 95% CI: 3.41 to 7.86; p < 0.00001). Conclusion:The addition of RBV may not contribute to a higher SVR rate and could increase the incidence of anemia, so RBV is not necessary in SOF-based DAAs for patients with HCV recurrence after LT.

Revolution in the diagnosis and management of hepatitis C virus infection in current era

“…Xue et al [ 193 ] reported 80% SVR 12 in 10 transplant recipients treated with SOF/RBV combination with PegIFN. The SOLAR 1 and SOLAR 2 trials reported 100% SVR 12 in 6 and 5 transplant recipients, respectively with FCH treated with SOF-LDV and RBV combination[ 119 , 120 ].…”

A new challenge for the Mexican health system: hepatitis C in people who inject drugs

“…Currently, there are direct-acting antiretroviral treatments for which the goal is to eliminate the virus from the body with an effectiveness rate of more than 95% depending on the genotype and co-infections. Nevertheless, high costs represent one of the main access barriers (Nápoles et al, 2019;Xue et al, 2019).…”