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Combined antiviral therapy of hepatitis C virus in dialysis patients: meta-analysis of clinical trials.
- Source :
-
Journal of viral hepatitis [J Viral Hepat] 2011 Jul; Vol. 18 (7), pp. e263-9. Date of Electronic Publication: 2010 Nov 25. - Publication Year :
- 2011
-
Abstract
- The efficacy and safety of combined interferon (IFN) plus ribavirin in patients on long-term dialysis and chronic hepatitis C remains unclear, although a number of small clinical trials have addressed this issue. We evaluated the efficacy and safety of combination antiviral therapy (conventional or pegylated interferon plus ribavirin) in dialysis patients with chronic hepatitis C by performing a systematic review of the literature with a meta-analysis of clinical trials. The primary outcome was sustained virological response (SVR) (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 10 clinical studies (151 unique patients), one (10%) of which was a controlled clinical trial. Most (97.4%) patients were on long-term haemodialysis. The summary estimate for SVR and drop-out rate was 56% [95% Confidence Intervals (95% CI) 28-84] and 25% (95% CI, 10-40), respectively. The most frequent side effects requiring interruption of treatment were anaemia (26%) and heart failure (9%). These results occurred irrespective of type of interferon (conventional or peg-IFN, peg-IFNalfa-2a or alfa-2b), trial design (controlled or cohort study), or clinical characteristics of patients (naïve, nonresponders or relapsers). The studies were heterogeneous with regard to SVR and drop-out rate. Combination antiviral therapy (interferon plus ribavirin) gives encouraging results in terms of efficacy and safety among dialysis patients even if the limited number of patients enrolled in our meta-analysis hampers definitive conclusions.<br /> (© 2010 Blackwell Publishing Ltd.)
- Subjects :
- Adult
Aged
Anemia chemically induced
Anemia complications
Antiviral Agents administration & dosage
Antiviral Agents adverse effects
Clinical Trials as Topic
Cohort Studies
Female
Heart Failure chemically induced
Heart Failure complications
Hepatitis C, Chronic complications
Humans
Interferon alpha-2
Interferon-alpha administration & dosage
Interferon-alpha adverse effects
Interferon-beta
Interferons administration & dosage
Interferons adverse effects
Male
Middle Aged
Polyethylene Glycols administration & dosage
Polyethylene Glycols adverse effects
Recombinant Proteins administration & dosage
Recombinant Proteins adverse effects
Recombinant Proteins therapeutic use
Renal Insufficiency complications
Renal Insufficiency therapy
Ribavirin administration & dosage
Ribavirin adverse effects
Treatment Outcome
Antiviral Agents therapeutic use
Drug Therapy, Combination adverse effects
Hepatitis C, Chronic drug therapy
Interferon-alpha therapeutic use
Interferons therapeutic use
Polyethylene Glycols therapeutic use
Renal Dialysis
Ribavirin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2893
- Volume :
- 18
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of viral hepatitis
- Publication Type :
- Academic Journal
- Accession number :
- 21108701
- Full Text :
- https://doi.org/10.1111/j.1365-2893.2010.01405.x