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

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 randomeffects 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 the I 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

Efetividade De Antivirais De Ação Direta No Tratamento Da Coinfecção Vírus Da Hepatite C E Vírus Da Imunodeficiência Humana

“…O presente estudo demonstrou que os tratamentos com DAA são seguros e com eventos adversos leves e pouco frequentes, o que pode favorecer a adesão ao tratamento e, consequentemente, resultar em cura da doença e impacto na redução da lista de espera e nos custos com transplante hepático devido à cirrose ou CHC por HCV. O alto índice de sucesso terapêutico com DAA está consistente com os dados da literatura, tanto em pacientes monoinfectados pelo HCV quanto na coinfecção HCV-HIV, em regime usual de curta duração de 12 semanas 28,29 .…”