HCV-1: DAAs 93% effective for post-LT recurrence

  • Liu J & al.
  • Transpl Infect Dis
  • 7 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Direct-acting antivirals (DAAs) are highly effective and well-tolerated for recurrent HCV-1 infection in liver transplant (LT) recipients.

Why this matters

  • This meta-analysis sheds light on the efficacy of various DAA combinations.

Study design

  • Meta-analysis of 16 studies involving 885 patients with HCV-1 post-LT recurrence treated with DAAs; 62.5% were conducted in the U.S. and most focused on genotype 1a.
  • Primary endpoint: sustained virologic response at 12 weeks posttherapy (SVR12).
  • Funding: Dutch Cancer Society, China Scholarship Council.   

Key results

  • Overall pooled estimate for SVR12 was 93% (95% CI, 89%-96%), with moderate heterogeneity (τ2=0.01, P<.001 i>2=75%) but no publication bias (P=.44).
  • Pooled estimate of serious adverse events was 4% (95% CI, 1%-7%), with high heterogeneity (τ2=0.02, P<.01 i>2=81%).
  • SVR12 by regimen ± ribavirin:
    • Ledipasvir/sofosbuvir (Harvoni), 100% (95% CI, 98%-100%).
    • Ritonavir-boosted paritaprevir/ombitasvir+dasabuvir (Viekira Pak, PrOD), 97% (95% CI, 89%-100%).
    • Simeprevir/daclatasvir (Olysio/Daklinza), 90% (95% CI, 80%-97%).
    • Simeprevir/sofosbuvir (Olysio/Sovaldi), 90% (95% CI, 87%-92%).
    • Asunaprevir (Sunvepra, in Japan) + daclatasvir (Daklinza), 81% (95% CI, 72%-89%).
  • SVR12 favored METAVIR F0-F2 vs F3-F4 fibrosis (93% [95% CI, 89%-96%] vs 83% [95% CI, 75%-88%]; P<.01>
  • No significant SVR12 difference with/without ribavirin (P=.23).
  • No difference in SVR12 between prospective and retrospective studies (P=.44).

Limitations

  • 12 of 16 studies were retrospective.
  • Simeprevir/sofosbuvir most commonly used.

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