Retreatment with pegylated interferon plus ribavirin of chronic hepatitis C non-responders to interferon plus ribavirin: A meta-analysis

Calogero Cammà, Giuseppe Cabibbo, Fabrizio Bronte, Marco Enea, Anna Licata, Massimo Attanasio, Angelo Andriulli, Antonio Craxì

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background/Aims: Efficacy of retreatment with pegylated interferon (PEG-IFN) plus ribavirin of non-responders to standard or pegylated IFN plus ribavirin has been assessed in various studies, but sustained virologic response (SVR) rates are variable and factors influencing efficacy and tolerability still remain incompletely defined. We aimed to focus on SVR rates and to identify factors influencing them in this meta-analysis. Methods: MEDLINE as well as a manual search were used. Studies were included if they were controlled or uncontrolled trials, if they had been published as full-length papers and if they included non-responders to standard or pegylated IFN and ribavirin therapy. Fourteen trials were included in the meta-analysis. Data on study populations, interventions, and outcomes were extracted from trials using a random-effects model. Primary outcome was the SVR rate. Results: The pooled estimate of SVR rate was 16.3% (95% Confidence Interval - 95% CI, 8.3-29.6%). There was a significant heterogeneity among studies (p <0.0001). Heterogeneity was less apparent in studies that included fewer patients with cirrhosis or overweight. By meta-regression, higher SVR rate was observed in trials with a lower prevalence of subjects with genotype 1 infection and with fewer overweight patients. The use of a 24-week retreatment stopping rule did not affect SVR rate. Conclusions: The overall modest efficacy argues against an indiscriminate retreatment with PEG-IFN and ribavirin of all non-responders. Restricting retreatment to non-overweight patients or to those with genotype 2 or 3 infection, using a 24-week retreatment stopping rule, would optimize the potential benefit with a scarce likelihood of missing a curative response.

Original languageEnglish
Pages (from-to)675-681
Number of pages7
JournalJournal of Hepatology
Volume51
Issue number4
DOIs
Publication statusPublished - Oct 2009

Fingerprint

Retreatment
Ribavirin
Chronic Hepatitis C
Interferons
Meta-Analysis
Genotype
Infection
MEDLINE
Sustained Virologic Response
Fibrosis
Confidence Intervals
Population

Keywords

  • HCV
  • Interferon
  • Ribavirin
  • Sustained virologic response

ASJC Scopus subject areas

  • Hepatology

Cite this

Retreatment with pegylated interferon plus ribavirin of chronic hepatitis C non-responders to interferon plus ribavirin : A meta-analysis. / Cammà, Calogero; Cabibbo, Giuseppe; Bronte, Fabrizio; Enea, Marco; Licata, Anna; Attanasio, Massimo; Andriulli, Angelo; Craxì, Antonio.

In: Journal of Hepatology, Vol. 51, No. 4, 10.2009, p. 675-681.

Research output: Contribution to journalArticle

Cammà, Calogero ; Cabibbo, Giuseppe ; Bronte, Fabrizio ; Enea, Marco ; Licata, Anna ; Attanasio, Massimo ; Andriulli, Angelo ; Craxì, Antonio. / Retreatment with pegylated interferon plus ribavirin of chronic hepatitis C non-responders to interferon plus ribavirin : A meta-analysis. In: Journal of Hepatology. 2009 ; Vol. 51, No. 4. pp. 675-681.
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T2 - A meta-analysis

AU - Cammà, Calogero

AU - Cabibbo, Giuseppe

AU - Bronte, Fabrizio

AU - Enea, Marco

AU - Licata, Anna

AU - Attanasio, Massimo

AU - Andriulli, Angelo

AU - Craxì, Antonio

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AB - Background/Aims: Efficacy of retreatment with pegylated interferon (PEG-IFN) plus ribavirin of non-responders to standard or pegylated IFN plus ribavirin has been assessed in various studies, but sustained virologic response (SVR) rates are variable and factors influencing efficacy and tolerability still remain incompletely defined. We aimed to focus on SVR rates and to identify factors influencing them in this meta-analysis. Methods: MEDLINE as well as a manual search were used. Studies were included if they were controlled or uncontrolled trials, if they had been published as full-length papers and if they included non-responders to standard or pegylated IFN and ribavirin therapy. Fourteen trials were included in the meta-analysis. Data on study populations, interventions, and outcomes were extracted from trials using a random-effects model. Primary outcome was the SVR rate. Results: The pooled estimate of SVR rate was 16.3% (95% Confidence Interval - 95% CI, 8.3-29.6%). There was a significant heterogeneity among studies (p <0.0001). Heterogeneity was less apparent in studies that included fewer patients with cirrhosis or overweight. By meta-regression, higher SVR rate was observed in trials with a lower prevalence of subjects with genotype 1 infection and with fewer overweight patients. The use of a 24-week retreatment stopping rule did not affect SVR rate. Conclusions: The overall modest efficacy argues against an indiscriminate retreatment with PEG-IFN and ribavirin of all non-responders. Restricting retreatment to non-overweight patients or to those with genotype 2 or 3 infection, using a 24-week retreatment stopping rule, would optimize the potential benefit with a scarce likelihood of missing a curative response.

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KW - Ribavirin

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