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Efficacy and safety of sofosbuvir/velpatasvir with or without ribavirin in hepatitis C genotype 3 compensated cirrhosis:A meta-analysis

查看全文 作　　者：Jing Hong [1]Loo;Wen Xin Flora [1]Xu;Jun Teck [1]Low;Wei Xuan [1]Tay;Le Shaun [1]Ang;Yew Chong [2]Tam;Prem Harichander [3]Thurairajah;Rahul [4,5]Kumar;Yu Jun [4,5]Wong 高影响力作者 机构地区：[1]Yong Loo Lin School of Medicine,National University of Singapore,Singapore 119077,Singapore;[2]Education Resource Center,Medical Board,Singapore General Hospital,Singapore 100059,Singapore;[3]Department of Gastroenterology and Hepatology,National University Hospital,Singapore 119077,Singapore;[4]Department of Gastroenterology and Hepatology,Changi General Hospital,Singapore 529889,Singapore;[5]Duke-NUS Medicine Academic Clinical Program,Singapore 100059,Singapore高影响力机构 出　　处：《World Journal of Hepatology》索引2022年第14卷第6期,共10页高影响力期刊 基　　金：Supported by the Nurturing Clinician Scientist Scheme(NCCS)award by SingHealth Duke-NUS Academic Medical Centre and National Medical Research Council Singapore. 摘　　要：BACKGROUND Hepatitis C virus(HCV)is a leading cause of liver cirrhosis and hepatocellular carcinoma globally.Sofosbuvir/velpatasvir(SOF/VEL)is an effective pangenotypic direct-acting antiviral combination for treatment of chronic HCV infection.While the addition of ribavirin(RBV)to SOF/VEL improved sustained virological response(SVR12)in genotype 3(GT3)decompensated cirrhosis patients,the benefits of RBV in GT3 compensated cirrhosis patients receiving SOF/VEL remains unclear.AIM To evaluate the efficacy and safety of SOF/VEL,with or without RBV in GT3 compensated cirrhosis patients.METHODS We searched four electronic databases(PubMed/Medline,Embase,Cochrane Library and Web of Science)from inception up to June 2021 using both free text and MeSH terms.There was no restriction on language,geography,publication dates and publication status(full text or abstracts).All GT3 compensated cirrhosis patients treated with 12 wk of SOF/VEL,with or without RBV,were included,regardless of age,gender or prior treatment experience.The primary outcome was sustained virological response 12-wk posttreatment(SVR12).The secondary outcome was treatment-related adverse events,as defined by symptomatic anemia requiring transfusion or a drop in hemoglobin beyond 2 g/dL.The pooled relative risk(RR),95%CI and heterogeneity(I^(2))were estimated using Review Manager version 5.3.RESULTS From 1752 citations,a total of seven studies(2 randomized controlled trials,5 cohort studies)with 1088 subjects were identified.The SVR12 was similar in GT3 compensated cirrhosis patients,regardless of the use of RBV,for both the intention-to-treat RR 1.03,95%CI:0.99-1.07;I^(2)=0%)and the per-protocol analysis(RR:1.03,95%CI:0.99-1.07;I^(2)=48%).The overall pooled rate of treatment-related adverse events was 7.2%.Addition of RBV increased the pooled risk of treatment-related adverse events in GT3 compensated cirrhosis patients receiving SOF/VEL(RR:4.20,95%CI:1.29-13.68;I^(2)=0%).Subgroup analysis showed that RBV was associated with a higher SVR12 in GT3 compensated cirrhosis patients with baseline resistance-associated substitutions.However,addition of RBV did not significantly increase the SVR12 among treatment-experienced GT3 compensated cirrhosis patients.CONCLUSION Ribavirin was not associated with higher SVR12 in GT3 compensated cirrhosis patients receiving SOF/VEL.Our findings suggest a limited role for RBV as routine add-on therapy to SOF/VEL in GT3 compensated cirrhosis patients. 关 键 词：Direct-acting antiviral Hepatitis C CIRRHOSIS Sofosbuvir/velpatasvir
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