Treatment of chronic hepatitis C in haemophilic patients with interferon and ribavirin: a meta-analysis

Hepatitis C virus (HCV) infection is a major cause of morbidity and mortality among haemophilic patients who were treated with clotting factor concentrates before the availability of virus-inactivated factors in the mid 1980s. In order to analyse the effect of the current combination anti-HCV treatm...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy Vol. 61; no. 6; p. 1191
Main Authors: Franchini, Massimo, Mengoli, Carlo, Veneri, Dino, Mazzi, Romualdo, Lippi, Giuseppe, Cruciani, Mario
Format: Journal Article
Language:English
Published: England 01.06.2008
Subjects:
Antiviral Agents - therapeutic use
Drug Therapy, Combination
Genotype
Hemophilia A - complications
Hepacivirus - classification
Hepacivirus - isolation & purification
Hepatitis C, Chronic - drug therapy
Humans
Interferons - therapeutic use
Ribavirin - therapeutic use
Treatment Outcome
Viremia
ISSN:1460-2091, 1460-2091
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Summary:Hepatitis C virus (HCV) infection is a major cause of morbidity and mortality among haemophilic patients who were treated with clotting factor concentrates before the availability of virus-inactivated factors in the mid 1980s. In order to analyse the effect of the current combination anti-HCV treatment [i.e. ribavirin plus interferon (IFN)] in this subset of HCV-infected patients, we performed a systematic review with meta-analysis of the available literature. The outcome was sustained viral suppression. When trials included for the main predictors two arms (positive and negative), the effect size was described as a comparative index [odds ratio (OR)] and a standard meta-analytical procedure was applied. However, when trials did not report the outcome in separate study arms, the effect size was a non-comparative index (success rate) and comparisons between predictor-positive and -negative studies were performed by meta-regression. Data involving 824 haemophilic HCV-infected patients treated with IFN plus ribavirin were collected from 18 articles (14 prospective cohort studies, 1 retrospective study and 3 randomized controlled trials). The higher rate of sustained viral response was observed in human immunodeficiency virus (HIV)-negative naive haemophiliacs treated with pegylated-IFN in combination with ribavirin (61%, ranging from 45% for genotype 1 to 79% for non-1 genotypes). Genotype 1 (OR, 0.15; 95% CI, 0.09-0.25) and co-infection with HIV (OR, 0.25; 95% CI, 0.08-0.81) were strong predictors of worse response to IFN therapy. Our meta-analysis shows that the pattern of response to combination anti-HCV therapy of chronically HCV-infected haemophiliacs is similar to that achieved in the general HCV-infected population.
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ISSN:1460-2091
1460-2091
DOI:10.1093/jac/dkn119