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Antiviral therapy of hepatitis C in chronic kidney diseases: meta-analysis of controlled clinical trials.
- Source :
-
Journal of viral hepatitis [J Viral Hepat] 2008 Aug; Vol. 15 (8), pp. 600-6. Date of Electronic Publication: 2008 Apr 28. - Publication Year :
- 2008
-
Abstract
- Hepatitis C virus (HCV) infection remains frequent in patients with chronic kidney disease and the detrimental role of HCV on survival is well-established in this population. Several authors have reported on efficacy and safety of antiviral therapy for hepatitis C in this polulation but there is no clear consensus on management. To evaluate efficacy and safety of antiviral therapy for hepatitis C in patients with chronic kidney disease, we performed a systematic review of the published medical literature and completed a meta-analysis of controlled clinical trials. The primary outcome was sustained virological response (as a measure of efficacy); the secondary outcome was drop-out rate (as a measure of tolerability). We used the random effects model of Der Simonian and Laird, with heterogeneity and sensitivity analyses. We identified 13 studies including 539 unique patients; 10 (76.9%) concerned patients on maintenance dialysis. Only prospective, controlled clinical trials were included. Pooling of study results showed a significant increase of viral response in study (patients treated with antiviral therapy) than control patients (patients who did not receive therapy), the pooled odds ratio (OR) of failure to obtain a sustained viral response was 0.081 [95% confidence intervals (CI), 0.029-0.230], P = 0.0001. The pooled OR of drop-out rate was significantly increased in study vs control patients, OR = 0.389 (95% CI, 0.155-0.957), P = 0.04. The studies were heterogeneous with regard to viral response and drop-out rate. In the subset of clinical trials (n = 6) involving only dialysis patients receiving interferon (IFN) monotherapy for chronic HCV, there was a significant difference in the risk of failure to obtain a sustained viral response (study vs control patients), OR = 0.054 (95% CI, 0.019; 0.150), P = 0.0001 (random-effects model). No significant (NS) heterogeneity was found (Q = 14.604, P = 1.0). No difference in the drop-out rate between study and control patients was shown, OR = 0.920 (95% CI, 0.367; 2.311), NS. This result being homogeneous (Q = 3.639, P = 0.388). Our meta-analysis showed that the viral response was greater in patients with chronic kidney disease who received antiviral therapy than controls. No difference in the drop-out rate between study and control patients occurred in the subgroup of dialysis patients on IFN monotherapy. These results support IFN-based therapy for hepatitis C in patients on maintenance dialysis.<br /> (© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd.)
- Subjects :
- Adult
Chronic Disease
Drug-Related Side Effects and Adverse Reactions epidemiology
Female
Humans
Male
Middle Aged
Randomized Controlled Trials as Topic
Treatment Outcome
Viral Load
Antiviral Agents administration & dosage
Antiviral Agents adverse effects
Hepatitis C drug therapy
Kidney Diseases complications
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2893
- Volume :
- 15
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of viral hepatitis
- Publication Type :
- Academic Journal
- Accession number :
- 18444984
- Full Text :
- https://doi.org/10.1111/j.1365-2893.2008.00990.x