Giuseppe Indolfi1, Loreto Hierro2, Antal Dezsofi3, Jörg Jahnel4, Dominique Debray5, Nedim Hadzic6, Piotr Czubkowski7, Girish Gupte8, Yael Mozer-Glassberg9, Wendy van der Woerd10, Françoise Smets11, Henkjan J Verkade12, Björn Fischler12,13. 1. Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy. 2. Pediatric Liver Service Hospital Infantil Universitario La Paz, Madrid, Spain. 3. First Department of Paediatrics, Semmelweis University, Budapest, Hungary. 4. Department of Pediatric and Adolescent Medicines, Medical University Graz, Graz, Austria. 5. Pediatric Centre, Hepatology, and Transplantation AP-HP, Hôpital Necker Enfants Malades, Paris, France. 6. Paediatric Gastrointestinal, Liver and Nutrition Centre, Variety Children's Hospital, King's College Hospital, NHS Foundation Trust, Denmark Hill, Camberwell, London, UK. 7. Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland. 8. Liver Unit (Including Small Bowel Transplantation), Department of Gastroenterology and Nutrition, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK. 9. Schneider Children's Medical Center, Petah Tikva, Israel. 10. Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands. 11. UCL, Cliniques Universitaires Saint-Luc, Pediatric Gastroenterology and Hepatology, Brussels, Belgium. 12. Department of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 13. Department of Paediatrics, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
Abstract
OBJECTIVES: In 2017, the European Medicines Agency and the Food and Drug Administration approved the use of the fixed-dose combination of ledipasvir/sofosbuvir and of the combination of sofosbuvir and ribavirin for treatment of adolescents (12-17 years or weighing >35 kg) with chronic hepatitis C virus (HCV) genotype 1, 4, 5, and 6 and genotype 2 and 3 infections, respectively. Although trials with direct-acting antivirals are ongoing for younger children, the only available treatment in the United States and Europe for those <12 years is still the dual therapy of pegylated interferon and ribavirin. There is currently a lack of a systematic approach to the care of these patients. The Hepatology Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition developed an evidence-based position paper for the management of chronic HCV infection in children. METHODS: A systematic literature search and meta-analysis were performed using MEDLINE and Embase from June 1, 2007 to June 1, 2017. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. European Society of Pediatric Gastroenterology, Hepatology and Nutrition Committee members voted on each recommendation, using the nominal voting technique. RESULTS: The efficacy of the different direct-acting antivirals combinations tested was higher, the relapse and the treatment discontinuation rates lower when compared to pegylated interferon and ribavirin. CONCLUSIONS: This position paper addresses therapeutic management issues including goals, endpoints, indications, contraindications, and the optimal treatment regimen in children with chronic HCV infection.
OBJECTIVES: In 2017, the European Medicines Agency and the Food and Drug Administration approved the use of the fixed-dose combination of ledipasvir/sofosbuvir and of the combination of sofosbuvir and ribavirin for treatment of adolescents (12-17 years or weighing >35 kg) with chronic hepatitis C virus (HCV) genotype 1, 4, 5, and 6 and genotype 2 and 3 infections, respectively. Although trials with direct-acting antivirals are ongoing for younger children, the only available treatment in the United States and Europe for those <12 years is still the dual therapy of pegylated interferon and ribavirin. There is currently a lack of a systematic approach to the care of these patients. The Hepatology Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition developed an evidence-based position paper for the management of chronic HCV infection in children. METHODS: A systematic literature search and meta-analysis were performed using MEDLINE and Embase from June 1, 2007 to June 1, 2017. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. European Society of Pediatric Gastroenterology, Hepatology and Nutrition Committee members voted on each recommendation, using the nominal voting technique. RESULTS: The efficacy of the different direct-acting antivirals combinations tested was higher, the relapse and the treatment discontinuation rates lower when compared to pegylated interferon and ribavirin. CONCLUSIONS: This position paper addresses therapeutic management issues including goals, endpoints, indications, contraindications, and the optimal treatment regimen in children with chronic HCV infection.
Authors: Daniel H Leung; Stefan Wirth; Betty B Yao; Rolando M Viani; Regino P Gonzalez-Peralta; Maureen M Jonas; Steven J Lobritto; Michael R Narkewicz; Etienne Sokal; Clàudia Fortuny; Evelyn K Hsu; Antonio Del Valle-Segarra; Jiuhong Zha; Lois Larsen; Li Liu; Diana L Shuster; Daniel E Cohen; Philip Rosenthal Journal: Hepatol Commun Date: 2018-10-05
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