HCV: ESPGHAN issues recommendations for pediatric treatment

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Takeaway

  • The European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) has issued a position paper regarding the treatment of pediatric HCV.

Why this matters

  • Ledipasvir/sofosbuvir (LDV/SOF) and sofosbuvir/ribavirin (SOF/RBV) are approved in the US/Europe for patients aged 12-17 years; peginterferon (PegIFN)+RBV  is used in younger children.

Study design

  • Systematic review/meta-analysis of studies involving PegIFN/RBV (11) or direct-acting antivirals (DAAs; 5).
  • ESPGHAN Hepatology Committee members voted on each recommendation.
  • Funding: None.

Recommendations

  • In the absence of high-risk factors, treatment can generally be deferred when PegIFN/RBV is the only option.
  • Interferon-free regimens are best for children aged >12 years weighing >35 kg; PegIFN/RBV is no longer recommended.
  • Children aged >12 years weighing >35 kg:
    • HCV-1/4: LDV/SOF for 12 weeks, extended to 24 weeks in treatment-experienced patients and those with compensated cirrhosis.
    • HCV-2: SOF plus weight-based RBV for 12 weeks.
    • HCV-3: SOF plus weight-based RBV for 24 weeks.
  • Children aged <12 years:
    • PegIFN/RBV is no longer recommended as a general treatment.
    • Treatment initiation should be individualized based on HCV genotype, liver disease severity, adverse effects, likelihood of response, and comorbidities.
    • Experienced treatment center is recommended.
    • Possible off-label use of DAAs could be considered.

Limitations

  • Few DAA trials, all with very short follow-up.