Interferon-based anti-viral therapy for hepatitis C virus infection after renal transplantation: an updated meta-analysis

• Published in: PloS one Vol. 9; no. 4; p. e90611
• Main Authors: Wei, Fang, Liu, Junying, Liu, Fen, Hu, Huaidong, Ren, Hong, Hu, Peng
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.04.2014; Public Library of Science (PLoS)
• Subjects: Antiviral agents; Antiviral Agents - therapeutic use; Biology and Life Sciences; Clinical trials; Clinical Trials as Topic; Effectiveness; Graft rejection; Health risk assessment; Hepacivirus - drug effects; Hepatitis; Hepatitis C; Hepatitis C - drug therapy; Hepatitis C - etiology; Heterogeneity; Humans; Infections; Interferon; Interferons - therapeutic use; Kidney Diseases - complications; Kidney Diseases - surgery; Kidney transplantation; Kidney Transplantation - adverse effects; Liver; Medical research; Medicine and health sciences; Meta-analysis; Morbidity; Patients; Physical Sciences; Polyethylene glycol; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Regression analysis; Rejection rate; Research and Analysis Methods; Ribavirin; Safety; Sensitivity analysis; Side effects; Studies; Systematic review; Therapy; Transplantation; Treatment Outcome; Viruses; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0090611

Hepatitis C virus (HCV) infection is highly prevalent in renal transplant (RT) recipients. Currently, interferon-based (IFN-based) antiviral therapies are the standard approach to control HCV infection. In a post-transplantation setting, however, IFN-based therapies appear to have limited efficacy and their use remains controversial. The present study aimed to evaluate the efficacy and safety of IFN-based therapies for HCV infection post RT. We searched Pubmed, Embase, Web of Knowledge, and The Cochrane Library (1997-2013) for clinical trials in which transplant patients were given Interferon (IFN), pegylated interferon (PEG), interferon plus ribavirin (IFN-RIB), or pegylated interferon plus ribavirin (PEG-RIB). The Sustained Virological Response (SVR) and/or drop-out rates were the primary outcomes. Summary estimates were calculated using the random-effects model of DerSimonian and Laird, with heterogeneity and sensitivity analysis. We identified 12 clinical trials (140 patients in total). The summary estimate for SVR rate, drop-out rate and graft rejection rate was 26.6% (95%CI, 15.0-38.1%), 21.1% (95% CI, 10.9-31.2%) and 4% (95%CI: 0.8%-7.1%), respectively. The overall SVR rate in PEG-based and standard IFN-based therapy was 40.6% (24/59) and 20.9% (17/81), respectively. The most frequent side-effect requiring discontinuation of treatment was graft dysfunction (14 cases, 45.1%). Meta-regression analysis showed the covariates included contribute to the heterogeneity in the SVR logit rate, but not in the drop-out logit rate. The sensitivity analyses by the random model yielded very similar results to the fixed-effects model. IFN-based therapy for HCV infection post RT has poor efficacy and limited safety. PEG-based therapy is a more effective approach for treating HCV infection post-RT than standard IFN-based therapy. Future research is required to develop novel strategies to improve therapeutic efficacy and tolerability, and reduce the liver-related morbidity and mortality in this important patient population.