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A new systematic review demonstrates efficacy of direct-acting antiviral therapies and supports a recommendation for universal screening of hepatitis C virus.
A new systematic review shows that new direct-acting antiviral therapies (DAAs) are highly effective at targeting hepatitis C virus (HCV) with few adverse effects.
The review, published in the Journal of the American Medical Association, updates a previous analysis from 2013, which found that interferon-based antiviral therapy was associated with increased likelihood of sustained virologic response (SVR). The new report focused on current DAA regimens and was expanded to include adolescents.
Moreover, the current review findings informed a new recommendation by the US Preventive Services Task Force (USPSTF) for universal screening of HCV. Cases of acute HCV infection have increased approximately 3.8-fold over the last decade, primarily due to increasing injection drug use and improved surveillance. In its newest recommendation, USPSTF concluded with moderate certainty that screening for HCV infection in adults aged 18 to 79 years has substantial net benefit.
For the review, the authors analyzed 8 randomized clinical trials of DAA therapy versus a placebo or an outdated antiviral regimen, 48 other treatment studies, and 33 cohort studies. A total of 179,230 individuals were included.
According to the new pooled data, SVR rates with currently recommended all-oral DAA regimens are substantially higher (>95%) than with interferon-based therapies evaluated in the previous 2013 review (68%-78%). DAA regimens were also linked to fewer harms than older interferon-containing therapies, according to the review.
“This has really been a remarkable advance in treatment,” corresponding author Roger Chou, MD, director of the Pacific Northwest Evidence-based Practice Center at Oregon Health & Science University (OHSU) and a professor of medicine in the OHSU School of Medicine, said in a press release. “Historically hepatitis C has been very difficult to treat, and the treatments were longer and difficult to tolerate. The new treatments are more effective but also have few side effects and therapy is usually completed in 8 to 12 weeks, compared with around a year previously.”
The authors noted that, as with the previous review, there was a consistent association between SVR after antiviral therapy and improved clinical outcomes, including mortality and hepatocellular carcinoma. However, direct evidence on the effect of DAAs on clinical outcomes is limited, indicating that further studies are needed to understand this association.
Evidence on DAA therapies in adolescents was limited, but consistently reported high (97%-100%) SVR rates, the review found.
1. Chou R, Dana T, Fu R, et al. Screening for hepatitis C virus infection in adolescents and adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2020. Doi: 10.1001/jama.2019.20788
2. US Preventive Services Task Force. Screening for hepatitis C virus infection in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2020. Doi: 0.1001/jama.2020.1123
3. OHSU-led evidence review shows new therapy for Hepatitis C is highly effective [news release]. OHSU’s website. https://news.ohsu.edu/2020/03/02/ohsu-led-evidence-review-shows-new-therapy-for-hepatitis-c-is-highly-effective. Accessed March 2, 2020.