Treatment of chronic hepatitis C in polytransfused thalassaemic patients: a meta-analysis

Abstract

Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality among thalassaemic patients. In order to analyse the effect of the current anti-HCV treatment in this subset of HCV-infected patients, we conducted a systematic review with meta-analysis of the available literature. The outcome was sustained viral response. Both comparative [odds ratio (OR)] and non-comparative indeces (success rate) were used to run the meta-analytical procedure. Data encompassing 429 thalassaemic HCV-infected patients treated with conventional or pegylated interferon monotherapy or combination therapy with ribavirin were collected from 13 articles (10 prospective cohort studies, 1 randomized-controlled trial and 2 controlled trials). Pooled sustained viralogical response (SVR) was 44.7% (34.6-54.9). Pooled ORs of SVR for Genotype 1 vs non-Genotype 1 infected thalassaemic patients were 0.46 (95% CI: 0.22-0.95) in IFN monotherapy and 1.7 (95% CI: 0.46-6.04) in ribavirin combination therapy. Our meta-analysis shows that thalassaemic patients with Genotype 1 infection significantly benefit from the addition of ribavirin to their therapeutic regimen. It seems that using ribavirin in thalassaemic patients increases transfusion need by a median of 30-40%, but does not increase major adverse events or treatment withdrawal. Current literature is lacking sufficient evidence about the use of PEG-IFN as monotherapy or in combination with ribavirin in thalassaemic patients.

IL28B polymorphisms influence stage of fibrosis and spontaneous or interferon-induced viral clearance in thalassemia patients with hepatitis C virus infection

“…The data on other analyzed SNPs showed that at least three different SNPs had a similar performance in association with SVR in genotype 1 patients. As reported in a previous analysis, 16 and in a meta-analysis by Alavian et al, 27 the rate of SVR in genotype 2 or 3 patients was higher than 60%, and there was no significant association between the SNPs analyzed and SVR in this group of patients. Despite the fact that the lack of correlation with IL28B SNPs may be related to very small numbers of genotype 2 or 3 patients in our cohort, this observation confirms data from other studies 25,[28][29][30] indicating that the prognostic value of SNPs for SVR may be limited to patients with difficult-to-treat genotypes even in this subset of patients.…”

“…A systematic review with metaanalysis on data from 429 TM patients with chronic HCV hepatitis treated with conventional or PEG-IFN monotherapy, or combination therapy with ribavirin, reported a pooled SVR of 44.7%, and concluded that genotype 1 TM patients significantly benefit from the addition of ribavirin to their therapeutic regimen. 27 There are no published data on the role of IL28B polymorphisms in genotype 1 TM patients treated with PEG-IFN and ribavirin but, as reported in large cohort studies of patients with chronic hepatitis and no hemoglobinopathies, [5][6][7] 'favorable' genotypes of rs12979860 or rs8099917 SNPs should be associated with a best response to standard of care also in this subset of patients, and the evaluation of their predictive values may become a component of future treatment decision-making algorithms.…”

“…27 In our cohort, 114 patients were treated with IFN monotherapy and were assessable for virological response. The overall SVR was 40.3% for treated patients, with a significant difference between genotype 1 (33.7%) and genotype 2 or 3 patients (64%).…”

Management of Chronic Hepatitis in Special Hosts and Special Situations: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

“…Bir meta-analizde PegIFN ve IFN monoterapisiyle veya RBV ile kombine edilerek izlenen 429 talasemili olgu değerlendirilmiştir. HCV genotip 1 infeksiyonunda kombinasyon rejimiyle daha iyi yanıt elde edilmiş, %30-40 daha fazla transfüzyon gerekmiş, ancak ilacı kesecek ölçüde ciddi yan etki gözlenmemiştir (204).…”

Safety and Efficacy of Direct-Acting Antivirals in Transfusion-Dependent Thalassemic Patients with Chronic Hepatitis C

“…was limited by poor tolerance, several contraindications, and concerns about RBV-induced haemolysis and the subsequent increase in transfusion needs (12). More recently, IFN-free regimens, based on directacting antivirals (DAAs), have been developed, showing greater efficacy and tolerance in patients with chronic HCV infection.…”