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

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.