Meta-analysis: antiviral treatment for hepatitis D
Article first published online: 24 JAN 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 6, pages 663–673, March 2012
How to Cite
Triantos, C., Kalafateli, M., Nikolopoulou, V. and Burroughs, A. (2012), Meta-analysis: antiviral treatment for hepatitis D. Alimentary Pharmacology & Therapeutics, 35: 663–673. doi: 10.1111/j.1365-2036.2012.04993.x
- Issue published online: 20 FEB 2012
- Article first published online: 24 JAN 2012
- Manuscript Accepted: 1 JAN 2012
- Manuscript Revised: 30 DEC 2011
- Manuscript Revised: 21 NOV 2011
- Manuscript Received: 4 NOV 2011
There is no satisfactory treatment for patients with hepatitis D (HDV).
To evaluate treatment for HDV using meta-analysis.
Medline, Scopus, Cochrane Library and ISI Web of Knowledge searches using the textwords ‘Hepatitis D’, ‘therapy’, “interferon”, “peginterferon”, “pegylated interferon”, “lamivudine”, “pegifn”, “ifn” and “Hepatitis D”, and abstracts from major Gastroenterology/Liver meetings. Endpoints: end of treatment biochemical (biochemical EOT) and virological response (virological EOT), end of follow-up virological response (EOFUP VR), histological improvement and intrahepatic HDAg clearance.
We included randomised clinical trials (RCTs) comparing Group A: interferon-A (IFNa) vs. no treatment (three RCTs, n ;= ;137 patients), Group B: low dose vs. high dose IFNa (two RCTs, n ;= ;60), Group C: IFNa ;+ ;lamivudine vs. IFNa (two RCTs, n ;= ;48) and Group D: pegylated IFNa (PEG-IFNa) vs. other medications (two RCTs, n ;= ;157). Group A. IFNa was better for biochemical EOT [OR, 0.11 (95% CI, 0.04–0.2)] and virological EOT [OR, 0.08 (95% CI, 0.03–0.2)], but not for EOFUP VR. Group B. High dose IFNa was better for biochemical EOT [OR, 0.24 (95% CI,0.08–0.73)] and virological EOT [OR, 0.27 (95% CI, 0.1–0.74)]. Group C. There was a trend favouring histological improvement [OR, 2.9 (95% CI, 0.6–13.4)]. Group D. PEG-IFNa was better for virological EOT [OR, 0.419 (95% CI, 0.18–0.974)], EOFUP VR [OR, 0.404 (95% CI, 0.189–0.866)] and improvement in necroinflammatory activity [OR, 0.308 (95% CI, 0.129–0.732)].
Long-term suppression of HDV RNA by IFNa is not maintained despite an end of treatment response; adding lamivudine is not beneficial. PEG-IFNa is superior to other medications with respect to EOT and EOFUP. New RCTs should test combinations of PEG-IFNa and newest antivirals.