Giuseppe Indolfi1, Björn Fischler2, Regino P Gonzalez-Peralta3, Mirta Ciocca4, Gilda Porta5, Mohan Neelam6, Mohamed El-Guindi7, Deirdre Kelly8, Yen-Hsuan Ni9, Anupan Sibal10, Daniel H Leung11, Mei Hwei Chang12. 1. Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy. 2. Department of Paediatrics, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden. 3. Pediatric GI, Hepatology and Liver Transplant, AdventHealth for Children and Transplant Institute, Atlanta, GA. 4. Pediatric Hepatology and Liver Transplant Section of German Hospital, Buenos Aires, Argentina. 5. Unidade de Hepatologia Instituto da Criança HC-FMUSP, São Paulo, Brazil. 6. Department of Pediatric Gastroenterology,Hepatology & Liver Transplantation, Medanta - The Medicity Hospital, Gurgaon, Haryana, India. 7. National Liver Institute, Menofiya University, Egypt. 8. Birmingham Women's and Children's Hospital and University of Birmingham, Birmingham, UK. 9. Department of Pediatrics, College of Medicine, National Taiwan University, Taipei, Taiwan. 10. Indraprastha Apollo Hospitals, New Delhi, India. 11. Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 12. Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Abstract
OBJECTIVE: This position paper written by the Hepatitis Expert Team of the Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition aimed to systematically evaluate clinical practice guidelines (CPGs), medical consensus, and position papers on the use of direct-acting antivirals (DAA) to treat chronic hepatitis C virus (HCV) infection in adolescents and children in order to compare recommendations and provide the basis for developing a unified position statement. METHODS: MEDLINE, Cochrane-Library, National Guideline Clearinghouse and select websites of relevant societies/organizations were used to identify CPGs, medical consensus and position papers between 2011-2019. RESULTS: A total of 5 documents were analysed: 3 CPGs, 1 medical consensus, and 1 position paper. All publications were consistent in recommending DAA treatment for adolescents (12-17 years old) with chronic HCV infection. Similarly, all of these publications consistently recommended deferring therapy for children between 3 and 11 years of age until DAA became available as standard of care. Finally, none of the included publications recommended treating children younger than 3 years old. By contrast, there was significant discrepancy across the retrieved documents regarding specific DAA regimens and treatment strategies. CONCLUSIONS: There is strong consensus on treating all adolescents with chronic HCV infection with DAA and on delaying therapy in younger children until these agents are approved for them. Interferon-based therapies should be avoided. Specific recommendations regarding which DAA regimen to use and treatment duration varied significantly. Key stakeholders need to convene to standardize therapeutic strategies at a global level if we are to eradicate HCV in children.
OBJECTIVE: This position paper written by the Hepatitis Expert Team of the Federation of International Societies of Pediatric Gastroenterology, Hepatology, and Nutrition aimed to systematically evaluate clinical practice guidelines (CPGs), medical consensus, and position papers on the use of direct-acting antivirals (DAA) to treat chronic hepatitis C virus (HCV) infection in adolescents and children in order to compare recommendations and provide the basis for developing a unified position statement. METHODS: MEDLINE, Cochrane-Library, National Guideline Clearinghouse and select websites of relevant societies/organizations were used to identify CPGs, medical consensus and position papers between 2011-2019. RESULTS: A total of 5 documents were analysed: 3 CPGs, 1 medical consensus, and 1 position paper. All publications were consistent in recommending DAA treatment for adolescents (12-17 years old) with chronic HCV infection. Similarly, all of these publications consistently recommended deferring therapy for children between 3 and 11 years of age until DAA became available as standard of care. Finally, none of the included publications recommended treating children younger than 3 years old. By contrast, there was significant discrepancy across the retrieved documents regarding specific DAA regimens and treatment strategies. CONCLUSIONS: There is strong consensus on treating all adolescents with chronic HCV infection with DAA and on delaying therapy in younger children until these agents are approved for them. Interferon-based therapies should be avoided. Specific recommendations regarding which DAA regimen to use and treatment duration varied significantly. Key stakeholders need to convene to standardize therapeutic strategies at a global level if we are to eradicate HCV in children.
Authors: Emanuele Nicastro; Lorenzo Norsa; Angelo Di Giorgio; Giuseppe Indolfi; Lorenzo D'Antiga Journal: World J Gastroenterol Date: 2021-05-28 Impact factor: 5.742