Treatment of chronic hepatitis C in polytransfused thalassaemic patients: a meta-analysis

• Published in: Journal of viral hepatitis Vol. 17; no. 4; pp. 236 - 244
• Main Authors: Alavian, S.-M., Tabatabaei, S.-V.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2010
• Subjects: Adolescent; Adult; Animals; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Clinical trials; Data processing; Drug Therapy, Combination; Female; Genotype; Genotype 1; Genotypes; HCV; Hepacivirus - classification; Hepacivirus - isolation & purification; Hepatitis C; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; Humans; Interferon; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Male; Morbidity; Mortality; non-Genotype 1; pegylated Interferon; Polyethylene Glycols - adverse effects; Polyethylene Glycols - therapeutic use; Recombinant Proteins; Reviews; Ribavirin; Ribavirin - adverse effects; Ribavirin - therapeutic use; RNA, Viral - blood; Thalassemia - complications; Transfusion; Treatment Outcome; Young Adult
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/j.1365-2893.2009.01170.x

Hepatitis C virus (HCV) infection is a major cause of liver‐related morbidity and mortality among thalassaemic patients. In order to analyse the effect of the current anti‐HCV treatment in this subset of HCV‐infected patients, we conducted a systematic review with meta‐analysis of the available literature. The outcome was sustained viral response. Both comparative [odds ratio (OR)] and non‐comparative indeces (success rate) were used to run the meta‐analytical procedure. Data encompassing 429 thalassaemic HCV‐infected patients treated with conventional or pegylated interferon monotherapy or combination therapy with ribavirin were collected from 13 articles (10 prospective cohort studies, 1 randomized‐controlled trial and 2 controlled trials). Pooled sustained viralogical response (SVR) was 44.7% (34.6–54.9). Pooled ORs of SVR for Genotype 1 vs non‐Genotype 1 infected thalassaemic patients were 0.46 (95% CI: 0.22–0.95) in IFN monotherapy and 1.7 (95% CI: 0.46–6.04) in ribavirin combination therapy. Our meta‐analysis shows that thalassaemic patients with Genotype 1 infection significantly benefit from the addition of ribavirin to their therapeutic regimen. It seems that using ribavirin in thalassaemic patients increases transfusion need by a median of 30–40%, but does not increase major adverse events or treatment withdrawal. Current literature is lacking sufficient evidence about the use of PEG‐IFN as monotherapy or in combination with ribavirin in thalassaemic patients.