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Meta-analysis of patients with hepatitis C virus genotype 6: 48 weeks with pegylated interferon and ribavirin is superior to 24 weeks

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Abstract

Background

Hepatitis C virus genotype 6 (HCV-6) is common in patients from Southeast Asia and the surrounding regions. Optimal treatment duration for HCV-6 is unknown given the inconclusive evidence from studies with varying methodologies and small sample sizes.

Methods

A literature search for ‘genotype 6’ in MEDLINE and EMBASE in October 2013 produced 161 and 251 articles, respectively. Additional abstracts were identified from four major international GI/liver conferences in 2012/2013. Inclusion criteria were original studies with ≥10 HCV-6 treatment-naïve patients treated with pegylated interferon + ribavirin (PEG IFN+RBV). Exclusion criteria were coinfections with HBV, HIV, other HCV genotypes, and/or other liver diseases. Primary outcome was pooled sustained virologic response (SVR). Heterogeneity was defined by Cochrane Q test (p value of 0.10) and I 2 statistic (≥50 %).

Results

A total of 13 studies with 641 patients were included. The pooled SVR estimate was 77 % (CI 70–83 %) (Q value = 38.4, p value <0.001, I 2 = 68.7 %) overall, 79 % (CI 73–84 %) for the 48-week group and 59 % (CI 46–70 %) for 24-week group, respectively. In studies with direct comparison of the two groups, SVR was superior in patients treated for 48 versus 24 weeks, OR 1.9 (CI 1.08–3.2, p = 0.026). In studies with direct comparison of patients with rapid virologic response (RVR), there was no difference in SVR between 48 versus 24 weeks, OR 1.74 (CI 0.65–4.64, p = 0.27).

Conclusion

Hepatitis C virus genotype 6 patients should be treated for 48 weeks, and those who achieve RVR may receive the shorter 24-week treatment duration. The high SVR (~80 %) with 48 weeks of PEG IFN+RBV therapy may be a cost-effective option for HCV-6 patients from resource-poor regions.

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Abbreviations

HCV:

Hepatitis C virus

SVR:

Sustained virologic response

RVR:

Rapid virologic response

PEG IFN+RBV:

Pegylated interferon and ribavirin

AASLD:

American Association for the Study of Liver Diseases

DDW:

Digestive disease week

APASL:

Asian Pacific Association for the Study of the Liver

EASL:

European Association for the Study of the Liver

RCT:

Randomized controlled trial

ITT:

Intention-to-treat

OR:

Odds ratio

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Acknowledgements

This project was supported in part by grant no. 1TL1RR03197 from the NIH National center for Research Resources to Nghia H. Nguyen and Shelley A. McCormack.

Compliance with ethical requirements and Conflict of interest

All procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and the Helsinki Declaration of 1975, as revised in 2000 and 2008. Nghia H. Nguyen, Shelley A. McCormack, Brittany E. Yee, Pardha Devaki, David Jencks, David T. Chao and Mindie H. Nguyen have no conflict of interest/financial disclosure.

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Authors and Affiliations

  1. School of Medicine, University of California, San Diego, CA, USA

    Nghia H. Nguyen, Shelley A. McCormack & Brittany E. Yee

  2. Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA

    Pardha Devaki

  3. Department of Internal Medicine, Stanford University, Palo Alto, CA, USA

    David Jencks

  4. Department of Internal Medicine, University of Pittsburg Medical Center, Pittsburg, PA, USA

    David T. Chao

  5. Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, CA, 94304, USA

    Mindie H. Nguyen

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  1. Nghia H. Nguyen
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Correspondence to Mindie H. Nguyen.

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Nguyen, N.H., McCormack, S.A., Yee, B.E. et al. Meta-analysis of patients with hepatitis C virus genotype 6: 48 weeks with pegylated interferon and ribavirin is superior to 24 weeks. Hepatol Int 8, 540–549 (2014). https://doi.org/10.1007/s12072-014-9570-4

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