Daclatasvir-based Treatment Regimens for Hepatitis C Virus Infection: A Systematic Review and Meta-Analysis

Abstract

ContextDirect acting antivirals (DAAs) have recently emerged as a promising therapeutic regimen for the treatment of hepatitis C virus (HCV) infection, which is a major public health problem. Among the known DAAs, daclatasvir (DCV), an inhibitor of the non-structural 5A protein, has been used in combination with several drugs for treatment of infection with HCV of different genotypes under different conditions. We conducted a systematic review and meta-analysis of combination therapy with DCV.Evidence AcquisitionWe performed a systematic search in PubMed, Scopus, Science Direct and Web of Science with appropriate keywords for DCV. Studies that evaluated any regimen containing DCV and reported the sustained virological response (SVR) 12 weeks after therapy based on the HCV genotype, treatment duration and use of ribavirin (RBV) were included. The selected studies were considered for meta-analysis using STATA 11.0.ResultsWe found six different regimens containing DCV: DCV/asunaprevir (ASV), DCV/ASV/beclubavir, DCV/pegylated interferon lambda or alpha/RBV with or without ASV, DCV/simeprevir, DCV/VX-135 and DCV/sofosbuvir (SOF). Most of these regimens were used for the treatment of HCV genotype 1 infections, and in most cases, treatment failure was noted in subtype 1a infections. Among all these regimens, DCV/SOF with or without RBV for 12 or 24 weeks was found to be an efficacious approach for treatment of different types of patients with infections with different HCV genotypes.ConclusionsAmong the treatment regimens containing DCV, DCV/SOF has the highest SVR rate for the treatment of infection with different HCV genotypes in different patient contexts; thus, this regimen shows promise for the treatment of HCV infections.

Update on Recommendations for the Clinical Management of Hepatitis C in Iran 2017

“…Treatment with suboptimal regimen of SOF + Pegylated Interferon (PegIFN) + RBV with around 90% efficacy in HCV-1 is not recommended anymore (3). In HCV-1 infected patients with a previous history of PegIFN + RBV therapy and/or cirrhosis (child A), intensification of 12 weeks of SOF/LDV or SOF + DCV with adding RBV is recommended, however, the latter groups can be treated with 12 weeks of SOF/VEL without addition of RBV (2,11,12). Moreover, decompensated cirrhosis (child B and C) patients with HCV-1 infection can be treated for 24 weeks of SOF/LDV, SOF + DCV or SOF/VEL with addition of RBV (4,6,11,13).…”

“…Recent real-world studies on treatment of HCV genotype 1 (HCV-1) infection demonstrated that 12 weeks of SOF/LDV, SOF + DCV or SOF/VEL is efficient for treatment of the HCV-1 infection in non-cirrhotic patients without previous history of HCV antiviral therapy (2,5,(10)(11)(12). Treatment with suboptimal regimen of SOF + Pegylated Interferon (PegIFN) + RBV with around 90% efficacy in HCV-1 is not recommended anymore (3).…”

Research progress on the direct antiviral drugs for hepatitis C virus

“…In the phase III ASTRAL trials, once-daily oral sofosbuvir plus velpatasvir for 12 weeks provided high rates of SVR12 in treatment-naive and -experienced patients with chronic HCV genotype 1-6 infection (22). This (31). The addition of beclubavir, an inhibitor of NS5B, to the daclatasvir/ asunaprevir regimen was found to improve the SVR rate in HCV-infected patients (31).…”

“…This (31). The addition of beclubavir, an inhibitor of NS5B, to the daclatasvir/ asunaprevir regimen was found to improve the SVR rate in HCV-infected patients (31). This regimen has been mainly used for the treatment of patients infected with HCV genotype 1 (subtypes 1a and 1b) and 4.…”

“…The daclatasvir and sofosbuvir combination regimen was approved by the European medicine agency for treatment of genotype 1-4 infections in 2014, followed by the FDA for treatment of genotypes 1 and 3 (32). According to several meta-analyses that analyzed the efficacy of this regimen on different genotypes, daclatasvir/sofosbuvir with and without ribavirin can be considered as a highly useful treatment option in treatment-naïve or treatment-experienced patients with genotype 1 and 3 infections with and without cirrhosis (31,33). The ability of daclatasvir to combine with other DAAs for treatment of patients with HCV infections under different conditions makes it a good choice for HCV treatment.…”