- A meta-analysis suggests limited utility for ribavirin (RBV) in patients receiving sofosbuvir (Sovaldi)-based direct-acting antiviral (DAA) regimens for HCV recurrence after liver transplant.
Why this matters
- Findings have important implications in the context of HCV+ organ donation.
- Pooled sustained virologic response at 12 weeks posttherapy (SVR12) rate, 91% (95% CI, 84%-95%), with high heterogeneity (I2=88%; P<.01 but no evidence of publication bias.>
- SVR12 was similar in patients receiving and not receiving RBV (90% vs 94%; risk ratio [RR]=0.97; P=.35; I2=46%), regardless of:
- Therapy duration of 12 vs 24 weeks (P=.26).
- DAA targets (NS3/4A+NS5B vs NS5A+NS5B inhibitors; P=.76).
- Studies conducted in the U.S. vs Europe (P=.13).
- RBV inclusion was associated with an increased prevalence of anemia (42% vs 10%; RR=5.18; P<.00001 i>2=26%).
- Meta-analysis of 12 studies involving 1466 liver transplant recipients receiving sofosbuvir-based DAA regimens with (n=502) and without RBV (n=964).
- HCV-1 was predominant (81%); approximately 58% were treatment-experienced.
- Primary endpoint: SVR12.
- Funding: National Natural Science Foundation of China, National Science and Technology Major Project of China, Chongqing Natural Science Commission Foundation.
- Only 1 randomized controlled trial included.
- No genotype-specific analysis.