Systematic review with meta‐analysis: effectiveness and tolerability of interferon‐free direct‐acting antiviral regimens for chronic hepatitis C genotype 1 in routine clinical practice in Asia.

Summary: Background: Direct‐acting antiviral (DAA) regimens have shown high efficacy and tolerability for patients with HCV genotype 1/1b (GT1/1b) in clinical trials. However, robust real‐world evidence of interferon (IFN)‐free DAA treatment for HCV GT1‐infected patients in Asia is still lacking. Aim: To systematically review and meta‐analyse the effectiveness and tolerability of IFN‐free DAA therapy for HCV GT1 infection in Asia. Methods: We included studies that enrolled adult patients with HCV GT1 infection in routine clinical practice in Asia, using IFN‐free DAA regimens, and reported sustained virological response (SVR) after 12/24 weeks end‐of‐treatment by 31 May 2017. The pooled SVR rates were computed with a random‐effects model. Subgroup analysis and meta‐regression as previously registered in PROSPERO were performed to determine how pre‐planned variables might have affected the pooled estimates. Results: We included 41 studies from eight countries and regions, comprising of 8574 individuals. The pooled SVR rates for GT1 were 89.9% (95% CI 88.6‐91.1, <italic>I</italic>² = 55.1%) with daclatasvir/asunaprevir (DCV/ASV) and 98.1% (95% CI 97.0‐99.0, <italic>I</italic>² = 41.0%) with ledipasvir/sofosbuvir ± ribavirin (LDV/SOF ± RBV). Baseline cirrhosis but not prior treatment history and age, attenuated the effectiveness of both regimens. Baseline resistance associated substitutions (RASs) severely attenuated SVR of DCV/ASV (65.4% vs 94.3%, <italic>P</italic> < 0.001) and only minimally with LDV/SOF ± RBV (94.5% vs 99.2%, <italic>P</italic> = 0.003). Patients with renal dysfunction treated with DCV/ASV showed a higher SVR rate (93.9% vs 89.8%, <italic>P</italic> = 0.046). Patients with hepatocellular carcinoma (HCC) LDV/SOF ± RBV achieved a lower SVR than those without HCC (94.1% vs 98.7%, <italic>P</italic> = 0.001). Conclusion: All oral DAA treatment of HCV GT1 resulted in high cure rates in Asian patients in routine clinical practice setting including elderly patients and those with end‐stage renal disease. [ABSTRACT FROM AUTHOR]