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Extended treatment duration for treatment naïve chronic hepatitis C genotype 1 late viral responders: a meta-analysis comparing 48 weeks vs 72 weeks of pegylated interferon and ribavirin

Authors


Gagan Sood, MD, Department of Gastroenterology and Hepatology, Baylor College of Medicine, 1709 Dryden Suite 1500, Houston, TX 77030, USA. E-mail: gksood@bcm.edu

Abstract

Summary.  Patients with genotype I chronic hepatitis C virus (HCV) infection with late virological response to therapy have low sustained viral response (SVR) with standard 48 weeks of therapy and may benefit from extended therapy. We performed a systematic review and meta-analysis of five studies to compare the outcome of 48 weeks vs 72 weeks treatment in treatment naïve chronic hepatitis C genotype I patients with late virological response. The end of treatment response with extended 72 weeks of treatment compared to standard 48 weeks of treatment was similar 48% and 56%, respectively, with pooled odds ratio (OR) (0.85; 95% CI 0.52–1.37). However, the SVR rates were higher with 72 weeks of treatment compared to 48 weeks treatment 32%vs 25% with pooled OR of 1.67 in favour of extended duration therapy (95% CI 1.16–2.40). This was because of lower relapse rates with extended duration therapy (35%vs 55%) with OR of 0.39 in favour of 72 weeks therapy (95% CI 0.25–0.61). There was no heterogeneity. No publication bias was noted as assessed by Egger’s test. Extending the treatment duration from 48 to 72 weeks in genotype 1 infected patients with late virological response improves SVR. Thus, therapy extension in genotype 1 late viral responders (LVR) may be a consideration to improve treatment response; however, the proportion of patients with LVR that might benefit from 72-week therapy appears to be small.

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