Pegylated Interferon Alfa-2b Plus Ribavirin in the Retreatment of Interferon-Ribavirin Nonresponder Patients

Taliani, Gloria; Gemignani, G; Ferrari, Carlo; Aceti, Antonio; Bartolozzi, Dario; Blanc, Pier Luigi; Capanni, M.; Esperti, Francesco; Forte, Paolo; Guadagnino, Vincenzo; Mari, T.; Marino, Nicoletta; Milani, Stefano; Pasquazzi, C.; Rosina, F.; Tacconi, Danilo; Toti, M; Zignego, Anna Linda; Messerini, Luca; Stroffolini, Tommaso

doi:10.1053/j.gastro.2006.02.016

Cited by 79 publications

(71 citation statements)

References 26 publications

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“…Of the remaining 42 full-text articles, 30 were excluded because they did not meet inclusion criteria, leaving 14 fulllength papers [3][4][5][6][7][8][9][10][11][12][13][14][15][16] meeting criteria for inclusion in the meta-analysis. Finally, 6 abstracts identified by manual search [17][18][19][20][21][22], were also included, only for the evaluation of the publication bias.…”

Section: Selection Of Trialsmentioning

confidence: 99%

“…The main features of the trials included in the meta-analysis are shown in Table 2 in Appendix. Fourteen, which accounted for 3898 patients, were reported as full papers [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Among the trials, three studies did not report the number of participating centers, while all remaining studies were multicenter trials, with the number of centers ranging from 2 to 133; among these studies 8 reported data on the prevalence of patients with cirrhosis (357/1282 = 27.8%).…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…The average value of BMI among the studies was 27.5 K/m 2 . The first treatment schedule was reported in five studies only [6,8,10,11,15], showing a large variability in the doses of standard IFN and ribavirin administered.…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…In 6 out of 14 studies (43%), both non-responders and relapsers were included. Eight studies [3,4,[6][7][8][9]13,16] met our definition for a ''good quality study," i.e. they fulfilled 2 or more of the four principal pre-defined quality criteria ( Table 1 in the Appendix).…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…Several studies of retreatment with pegylated IFN (PEG-IFN) plus ribavirin in patients who failed to respond to the combination of pegylated and non-pegylated IFN plus ribavirin have been published [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The results of these studies are inconclusive or conflicting because of the relatively small samples and the differences in patient characteristics, study design combining relapsers and nonresponders, doses of IFN and ribavirin administered in the first course, and retreatment regimens.…”

Section: Introductionmentioning

confidence: 99%

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Retreatment with pegylated interferon plus ribavirin of chronic hepatitis C non-responders to interferon plus ribavirin: A meta-analysis

Cammà

Cabibbo

Bronte

et al. 2009

Journal of Hepatology

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Background/Aims: Efficacy of retreatment with pegylated interferon (PEG-IFN) plus ribavirin of non-responders to standard or pegylated IFN plus ribavirin has been assessed in various studies, but sustained virologic response (SVR) rates are variable and factors influencing efficacy and tolerability still remain incompletely defined. We aimed to focus on SVR rates and to identify factors influencing them in this meta-analysis.Methods: MEDLINE as well as a manual search were used. Studies were included if they were controlled or uncontrolled trials, if they had been published as full-length papers and if they included non-responders to standard or pegylated IFN and ribavirin therapy. Fourteen trials were included in the meta-analysis. Data on study populations, interventions, and outcomes were extracted from trials using a random-effects model. Primary outcome was the SVR rate.Results: The pooled estimate of SVR rate was 16.3% (95% Confidence Interval -95% CI, 8.3-29.6%). There was a significant heterogeneity among studies (p < 0.0001). Heterogeneity was less apparent in studies that included fewer patients with cirrhosis or overweight. By meta-regression, higher SVR rate was observed in trials with a lower prevalence of subjects with genotype 1 infection and with fewer overweight patients. The use of a 24-week retreatment stopping rule did not affect SVR rate.Conclusions: The overall modest efficacy argues against an indiscriminate retreatment with PEG-IFN and ribavirin of all non-responders. Restricting retreatment to non-overweight patients or to those with genotype 2 or 3 infection, using a 24-week retreatment stopping rule, would optimize the potential benefit with a scarce likelihood of missing a curative response. Ó

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