Response to standard of care antiviral treatment in patients with HCV liver cirrhosis

Response to Standard of Care Antiviral Treatment in Patients with HCV Liver Cirrhosis – a Systematic Review

Simona Bota1, Ioan Sporea1, Alina Popescu1, Roxana Sirli1, Adriana Maria Neghina2, Mirela Danila1, Mihnea Strain11) Department of Gastroenterology and Hepatology; 2) Department of Biochemistry, Victor Babes University of Medicine and Pharmacy, Timi oara, Romania

Abstract

Background:Patients with HCV liver cirrhosis are a category difficult to treat. The aim of this study was to establish the sustained virological response (SVR) rates in HCV patients with liver cirrhosis treated with standard of care therapy (Pegylated Interferon and Ribavirin for 48 weeks in genotypes 1 and 4 and 24 weeks in genotypes 2 and 3). methods:Searching the PubMed, Medline, Lilacs, Scopus, Ovid and Medscape databases we identified all the articles published until February 2011 that included only HCV cirrhotic patients. These studies evaluated the SVR after standard of care treatment: Pegylated Interferon alpha 2a (doses ranging between 135-180 µg/week) or Pegylated Interferon alpha 2b (1 or 1.5 µg/kg/week) and Ribavirin (doses ranging between 800-1200 mg/day). We used the following key words: HCV, liver cirrhosis, sustained virological response (SVR). Results:The overall SVR rate was 33.3% (95%CI-confidence interval=30.6-36.2%). SVR was significantly higher in patients with genotypes 2 and 3 (422 patients) as compared to those with genotypes 1 and 4 (692 patients): 55.4% (95%CI=50.7-60.1) versus 21.7% (95%CI=18.7-25), p<0.0001. Conclusion:The overall SVR rate in cirrhotic patients treated with standard of care therapy is 33.3%, but lower in cases affected by genotypes 1 and 4 (21.6%) which makes them a priority regarding the development of more potent drugs for effective treatment.

Introduction

Chronic HCV infection is an important public health concern worldwide. The World Health Organization has estimated the prevalence of HCV infection at about 3%, with approximately 170 million affected people [1]. In Europe, the estimated prevalence of 1% varies largely among different countries [2]. HCV is responsible for 25-30% of global cases of cirrhosis associated with an annual risk of hepatic decompensation and hepatocellular carcinoma in up to 5% and 1-4% cases, respectively [3-4]. In patients with compensated liver cirrhosis, the 5-year risk of decompensation is estimated at 15-28%, and the risk of hepatocellular carcinoma is 1.4-6.7% annually [5-6]. HCV liver cirrhosis is the most common indication for liver transplantation. In patients with detectable viral HCV load before transplantation, recurrence of HCV is universal and immediate after transplantation [7]. Some studies show that both the graft and the patients’ survival rates in HCV-infected cases are shorter as compared to non-HCV-infected ones following liver transplantation [8].

Pegylated Interferon and Ribavirin represent the standard of care (SOC) treatment in chronic HCV infection. In randomized controlled trials, the SVR rates were reported as follows: 42-46% in patients with genotype 1 infection, and 76-82% in patients with genotype 2 or 3 infection [9-10].Patients with HCV-related cirrhosis usually have a poor therapeutic response as well as reduced tolerance to therapy [11-12], but the risk of complications is reduced in patients Key words

with SVR [13].

Hepatitis C – HCV – liver cirrhosis – sustained This systematic review aims at identifying and analyzing virological response – systematic review – pegylated the pooled SVR rates in HCV patients with liver cirrhosis interferon – ribavirin. treated with SOC therapy.

Received: 26.07.2011 Accepted: 24.08.2011J Gastrointestin Liver Dis

September 2011 Vol. 20 No 3, 293-298Address for correspondence: Prof. Ioan Sporea Department of Gastroenterology and Hepatology University of Medicine and Pharmacy Timisoara, Romania Email: isporea@umft.ro

methods

Eligibility criteria

This review included all studies published in English until February 2011 which evaluated the SVR rates in cirrhotic patients with HCV infection treated with SOC therapy: Pegylated Interferon alpha 2a (dosage range: 135-180 µg/

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