HCV: DAAs yield good response with recent drug use, OST

  • Hajarizadeh B & al.
  • Lancet Gastroenterol Hepatol
  • 20 Sep 2018

  • curated by Yael Waknine
  • Univadis Clinical Summaries
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Takeaway

  • Response to HCV direct-acting antivirals (DAA) is favorable among patients with recent drug use (including injectable drug use [IDU]) or receiving opioid substitution therapy (OST).

Why this matters

  • Some countries still restrict reimbursement based on drug use.
  • Clinicians often have concerns regarding adherence and response.

Study design

  • Meta-analysis of 38 studies (n=3634).
  • Recent drug use often defined as within past 6 months, or at beginning/during DAA therapy.
  • Efficacy endpoint was intent-to-treat rate of sustained virologic response at 12 weeks post-therapy (SVR12).
  • Funding: Kirby Institute, UNSW Sydney, National Health and Medical Research Council of Australia.     

Key results

  • Recent drug use (injecting/noninjecting; 21 studies, n=1408): treatment completion rate was 97.5% (95% CI, 96.6%-98.3%), SVR12 was 87.7% (95% CI, 84.2%-91.3%).
  • OST (36 studies, n=2987) completion rate was 97.4% (95% CI, 96.5%-98.3%) and SVR12 was 90.7% (95% CI, 88.5%-93.0%).
  • Recent IDU (8 studies, n=670): completion rate was 96.9% (95% CI, 95.6%-98.2%) and SVR12 was 87.4% (95% CI, 82.0%-92.8%).
  • Factors associated with SVR12 included clinical trial participation (aOR=2.18; P=.006) and higher mean/median age (aOR=1.07; P=.008).
  • Clinical trials and higher mean/median age were associated with less loss to follow-up (aOR=0.45 [P=.0033] and aOR=0.94 [P=.034], respectively).

Limitations

  • Self-reported injecting drug use.
  • Impact of adherence interventions not captured.

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