Submit Article
Back to Journal

SM Journal of Hepatitis Research and Treatment

A Systematic Review And Meta-Analysis of Ribavirin with Newer Directly Acting Antivirals in the Treatment of HCV

[ ISSN : 2573-3672 ]

Abstract
Details

Received: 08-Jun-2017

Accepted: 26-Jun-2017

Published: 29-Jun-2017

Research Article | Volume 3 - Issue 1 | Article DOI : 10.36876/smjhrt.1012

Download PDF

Mark M Aloysius¹#, Niraj J Shah²*#, Nimy John³, Ked Fortuzi⁴, Elona Shehi⁴, Robert S Brown⁴ and Patrick P Basu⁴

¹Department of Medicine, James J Peters VA Medical Center, Icahn-School of Medicine at Mount Sinai, USA
²Department of Medicine, Division of Digestive Disease, University of Mississippi Medical Center, USA
³Department of Medicine, St. Vincent’s Medical Center, University of Massachusetts, USA
?Department of Medicine, Division of Gastroenterology and Hepatology, Weill-Cornell Medical College, USA

#Both authors contributed equally

Corresponding Author:

Niraj James Shah, Department of Medicine, Division of Digestive Diseases, The University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA, Tel: 001-601- 984-4540 (extension 7915); Fax: 001- 601-984-4548; Email(s): jnshah@umc. edu (or) nirajjames@gmail.com

Abstract

Background: In the current era of interferon free oral Directly Acting Antivirals (DAAs), Ribavirin (RBV) is widely used. A relevant question in focus is the value of RBV to date, from the accrual of data from all clinical studies and real world data. We aimed to assess the efficacy of DAAs in combination with RBV compared with DAAs without RBV, and discuss pertinent literature.

Methods: We identified studies through a systematic review of PubMed, Embase, Clinical Trials.gov, meeting abstracts and a national HCV database repository (HCV Target). We used cumulative random effects meta-analysis to combine effect estimates from the data.

Findings: We included 19 studies that met the inclusion criteria. The meta-analysis of HCV patients comprised data for 9350 patients (DAAs with RBV=3371, DAAs alone=5979). The baseline characteristics were similar between the two groups. In cumulative meta-analysis adjusted for age, sex, previous treatment failure, IL28 beta genotype, and male sex no factor was associated with a statistically significant increase in SVR 12.The use of RBV with DAA for HCV was not associated with a significant increase in SVR 12 rates compared with the use of DAA alone in all patients OR of 0.90 (95% CI 0.53-1.53; p=0.7), in the subgroup of cirrhotic patients OR of 0.99 (95% CI 0.53-1.85; p=0.98), in the subgroup of treatment experienced patients OR of 1.19 (95% CI 0.80- 1.75; p=0.65) and in the subgroup of G3 patients OR of 0.97 (95% CI 0.25-3.71; p=0.96). The adverse effects of RBV appears to be mostly non-fatal but contributes to significant morbidity.

Interpretation: Although the use of RBV with DAAs is common in the era of IFN free therapy, its synergistic effect with DAAs in clinical studies to achieve superior SVR 12 rates remains inconclusive. Therefore the use of RBV with DAAs needs to cautiously reconsidered in all patients with HCV, especially in those at risk for serious adverse events.

Citation

Aloysius MM, Shah NJ, John N, Fortuzi K, Shehi E, Brown RS, et al. A Systematic Review And Meta: Analysis of Ribavirin with Newer Directly Acting Antivirals in the Treatment of HCV. SM J Hepat Res Treat. 2017; 3(1): 1012. https://dx.doi.org/10.36876/smjhrt.1012