Helena H Borba1, Astrid Wiens1, Laiza M Steimbach1, Cassio M Perlin1, Fernanda S Tonin1, Maria L A Pedroso2, Fernando Fernandez-Llimos3, Roberto Pontarolo4. 1. Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Campus III, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, 80210-170, Brazil. 2. Gastroenterology Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil. 3. Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal. 4. Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Campus III, Av. Pref. Lothário Meissner, 632, Jardim Botânico, Curitiba, PR, 80210-170, Brazil. pontarolo@ufpr.br.
Abstract
PURPOSE: This study aimed to compare the efficacy among direct-acting antiviral agents (first and second-generation direct-acting antiviral agents (DAAs)) with placebo and with standard dual therapy (pegylated interferon + ribavirin (Peg-IFN + RBV)) in terms of rapid virologic response (RVR) and sustained virologic response (SVR) in chronic hepatitis C genotype 1 treatment. METHODS: We performed a systematic review of randomized controlled trials (RCTs) in MEDLINE, International Pharmaceutical Abstracts, Cochrane Library, SCIELO, and Scopus and conducted a network meta-analysis to compare the efficacy of boceprevir (BOC), daclatasvir (DCV), grazoprevir, simeprevir (SMV) and telaprevir (TVR), in treatment-naive and treatment-experienced patients. RESULTS: Sixteen studies encompassing 7171 patients were analysed. Associations between DAAs therapies (IFN-free regimens) could not be addressed since no common comparator was found in the RCTs among these associations and the other agents included in the present analysis. All agents were more efficacious than placebo or Peg-IFN + RBV in terms of RVR, while only BOC and SMV showed statistically significant superiority for the SVR outcome when compared to placebo or standard dual therapy. No significant differences between the DAAs were observed. The analysis prioritized treatment with DCV for both efficacy outcomes. Node-splitting analysis showed that our networks are robust (p > 0.05). CONCLUSIONS: The superiority of DAAs over placebo or standard dual therapy with Peg-IFN + RBV was confirmed, indicating the greater efficacy of DCV. This study is the first network meta-analysis that included RVR as an outcome in the evaluation of these agents via indirect comparison. Further investigation should be carried out addressing safety and tolerability outcomes.
PURPOSE: This study aimed to compare the efficacy among direct-acting antiviral agents (first and second-generation direct-acting antiviral agents (DAAs)) with placebo and with standard dual therapy (pegylated interferon + ribavirin (Peg-IFN + RBV)) in terms of rapid virologic response (RVR) and sustained virologic response (SVR) in chronic hepatitis C genotype 1 treatment. METHODS: We performed a systematic review of randomized controlled trials (RCTs) in MEDLINE, International Pharmaceutical Abstracts, Cochrane Library, SCIELO, and Scopus and conducted a network meta-analysis to compare the efficacy of boceprevir (BOC), daclatasvir (DCV), grazoprevir, simeprevir (SMV) and telaprevir (TVR), in treatment-naive and treatment-experienced patients. RESULTS: Sixteen studies encompassing 7171 patients were analysed. Associations between DAAs therapies (IFN-free regimens) could not be addressed since no common comparator was found in the RCTs among these associations and the other agents included in the present analysis. All agents were more efficacious than placebo or Peg-IFN + RBV in terms of RVR, while only BOC and SMV showed statistically significant superiority for the SVR outcome when compared to placebo or standard dual therapy. No significant differences between the DAAs were observed. The analysis prioritized treatment with DCV for both efficacy outcomes. Node-splitting analysis showed that our networks are robust (p > 0.05). CONCLUSIONS: The superiority of DAAs over placebo or standard dual therapy with Peg-IFN + RBV was confirmed, indicating the greater efficacy of DCV. This study is the first network meta-analysis that included RVR as an outcome in the evaluation of these agents via indirect comparison. Further investigation should be carried out addressing safety and tolerability outcomes.
Authors: Xavier Forns; Eric Lawitz; Stefan Zeuzem; Ed Gane; Jean Pierre Bronowicki; Pietro Andreone; Andrzej Horban; Ashley Brown; Monika Peeters; Oliver Lenz; Sivi Ouwerkerk-Mahadevan; Jane Scott; Guy De La Rosa; Ronald Kalmeijer; Rekha Sinha; Maria Beumont-Mauviel Journal: Gastroenterology Date: 2014-03-03 Impact factor: 22.682
Authors: Stanislas Pol; Reem H Ghalib; Vinod K Rustgi; Claudia Martorell; Greg T Everson; Harvey A Tatum; Christophe Hézode; Joseph K Lim; Jean-Pierre Bronowicki; Gary A Abrams; Norbert Bräu; David W Morris; Paul J Thuluvath; Robert W Reindollar; Philip D Yin; Ulysses Diva; Robert Hindes; Fiona McPhee; Dennis Hernandez; Megan Wind-Rotolo; Eric A Hughes; Steven Schnittman Journal: Lancet Infect Dis Date: 2012-06-18 Impact factor: 25.071