DSEN Abstract
Drugs for Chronic Hepatitis C Infection: A Systematic Review and Network Meta-analysis

Summary and key messages

The systematic review was limited by the quality of the 67 included studies; overall quality was adequate.
Due to a lack of comparative studies, we applied novel methods to incorporate single-arm studies into the NMA by creating a "virtual" study, in which a comparator arm was matched for baseline patient characteristics identified in the single arm.
Efficacy and safety varies by population (treatment naïve, experienced), genotype (1 to 6) and by treatment regimen.
Very little data were available for individuals with advanced liver disease, co-infections with HIV or with genotype 5 and 6.

The effectiveness and safety of hepatitis C treatments vary depending on factors such as virus genotype, previous treatment history, liver health and co-existing conditions. Choosing the right treatment should be based on the individual needs and characteristics of each patient.

Authors: Shannon E. Kelly, Bechara Farah, Sumeet Singh, Li Chen, Shuching Hsieh, David Kaunelis, George A. Wells

For more information, please contact:
George A. Wells
gawells@ottawaheart.ca

Chronic hepatitis C (CHC) infection can cause severe liver problems, including liver failure and liver cancer. Until recently, treatment often involved interferon-based therapies, which were difficult for many patients to tolerate due to side effects, drug interactions and complex dosing.
New medications, known as direct-acting antivirals, have become available and may offer better outcomes with fewer side effects. However, these treatments are expensive, and policy-makers need reliable information to decide who should get access to them and under what circumstances.

This systematic review and network meta-analysis (NMA) aimed to compare the safety and effectiveness of currently approved and new treatment regimens for CHC infection across all six known virus genotypes. The findings were intended to guide decisions about drug funding and treatment access in Canada.

First, we conducted a broad systematic review of the available evidence in the published literature, updating the literature on genotype 1 from a previous review and identifying all studies for genotypes 2 to 6.
The main efficacy outcome of interest was sustained virologic response (SVR) at 12 or 24 weeks. Key safety outcomes were rash, depression and anemia.
Second, a NMA was conducted to compare the available treatment regimens reporting outcomes of interest.
We made adjustments to conventional NMA methodology in order to incorporate the single-arm cohort evidence as limited comparative evidence was available.

A total of 67 unique studies were included in this review. Studies predominantly reported on patients with CHC genotype 1 infection, or a mix of patients with genotype 1 and other genotypes.
Results in full are available in the published systematic review (National Library of Medicine NBK355769).

Publication: Wells et al., 2016; NBK350686