Issue: 2011 > May > review

Treatment extension benefits HCV genotype 1 patients without rapid virological response: a systematic review

T.J.G. Gevers, S. Slavenburg, M.G.H. van Oijen, J.P.H. Drenth


Background: Current guidelines recommend 48 weeks
of treatment with pegylated interferon and ribavirin for
patients infected with chronic hepatitis C virus (HCV)
genotype 1. Several clinical trials have investigated the
efficacy of treatment duration longer than 48 weeks, but
yielded discordant results. Methods: We performed a structured search of PubMed, Web of Science and the Cochrane library to identify randomised clinical trials in HCV genotype 1 patients who were treated either for 48 or 72 weeks. Sustained viral response (SVR) data were pooled and a sample size weighted pooled proportion was calculated. Results: We identified five studies matching our criteria. Studies randomised at baseline (n=1), at absence of rapid virological response (RVR) at week 4 (n=1), at early virological response at week 12 (EVR) (n=1) or at slow response at week 24 (n=2). In the RCT that randomised at absence of RVR, SVR was
significantly higher in the extended treatment arm (57 vs 42%, p=0.02) with an RR of 1.35 (95% CI 1.04 to 1.75). This tendency was also observed in the studies that randomised at slow response (44 vs 35%), although no longer statistically significantly different. Conclusion: Prolonged 72-week treatment should be considered in HCV genotype 1 patients without RVR at week 4, as this increased SVR.