Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 18, 2015; 7(5): 806-813
Published online Apr 18, 2015. doi: 10.4254/wjh.v7.i5.806
Impact of all oral anti-hepatitis C virus therapy: A meta-analysis
Siddharth Bansal, Ashwani K Singal, Brendan M McGuire, Bhupinder S Anand
Siddharth Bansal, Department of Internal Medicine, University of Alabama Birmingham, Birmingham, AL 35294, United States
Ashwani K Singal, Brendan M McGuire, Department of Gastroenterology and Hepatology, University of Alabama Birmingham, Birmingham, AL 35294, United States
Bhupinder S Anand, Department of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX 77030, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest: No conflict of interest or disclosure by any author.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at ashwanisingal.com@gmail.com. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ashwani K Singal, MD, MS, Assistant Professor, Department of Gastroenterology and Hepatology, University of Alabama Birmingham, 1720 2nd Ave S, Birmingham, AL 35294, United States. ashwanisingal.com@gmail.com
Telephone: +1-205-9345623 Fax: +1-205-9759777
Received: December 2, 2014
Peer-review started: December 2, 2014
First decision: January 8, 2015
Revised: February 3, 2015
Accepted: March 5, 2015
Article in press: March 9, 2015
Published online: April 18, 2015
Processing time: 138 Days and 14.7 Hours
Abstract

AIM: To investigate the efficacy, safety, and cost of treatment of direct acting antivirals (DAAs) with and without peg interferon alfa2a (P), and/or ribavirin (R) in treating hepatitis C virus (HCV) genotype 1 patients.

METHODS: MEDLINE was searched for randomized controlled trials (RCT) using DAAs for HCV treatment. Phase 1 trials and studies with investigational drugs on genotype 2 or 3, and on human immunodeficiency virus patients were excluded. Data were pooled for sustained virologic response (SVR), serious adverse effects, and drug discontinuation rate on various treatment arms in trials: P + R; 1st generation DAA (telaprevir or boceprevir) + P + R; 2nd generation DAA (sofosbuvir or simeprevir) + P + R; 2nd generation DAA + R; two 2nd generation DAA + R; and two 2nd gen DAA. Data were analyzed separately for each arm for treatment naive and non-responders (NR) to previous treatment. The cost of treatment with each regimen for achieving one SVR was also compared.

RESULTS: Twenty three RCTs (n = 9354, 62% male, 11% cirrhosis) were analyzed. All oral (P free) regimens with combination of 2 DAA achieved SVR above 95%. The cost of treatment to achieve an SVR with DAA based regimens was lower for NR compared to P+R regimen. However, the cost per SVR remained higher for treatment naive patients.

CONCLUSION: Second generation and emerging DAAs are promising agents in HCV treatment, with a very high level of safety and efficacy. An important drawback is their high cost. However, the present meta-analysis shows that the cost per SVR for non responders (but not for naive patients) was lower compared to P + R. This finding together with the superior safety profile and better compliance makes these drugs highly attractive. It is possible that further reduction in treatment duration may make them even more cost effective.

Keywords: Hepatitis C; Meta-analysis; Direct acting antivirals; Oral agents; Newer agents; Hepatitis C virus

Core tip: Data are rapidly evolving on the efficacy and safety of newer oral direct acting antivirals (DAAs) for treating hepatitis C virus (HCV) infection. Second generation and emerging DAAs are promising agents in HCV treatment, with a very high level of safety and efficacy. An important drawback is their high cost. However, the present meta-analysis shows that the cost per sustained virologic response for non responders (but not for naive patients) was lower compared to peg interferon alfa2a + ribavirin. This finding together with the superior safety profile and better compliance makes these drugs highly attractive.