Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2016; 22(22): 5285-5292
Published online Jun 14, 2016. doi: 10.3748/wjg.v22.i22.5285
Hepatitis C virus genotype 3: Meta-analysis on sustained virologic response rates with currently available treatment options
Javier Ampuero, K Rajender Reddy, Manuel Romero-Gomez
Javier Ampuero, Manuel Romero-Gomez, Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen Macarena, Virgen del Rocío University Hospitals, University of Sevilla, 41018 Sevilla, Spain
Javier Ampuero, Manuel Romero-Gomez, Instituto de Biomedicina de Sevilla, 41018 Sevilla, Spain
K Rajender Reddy, Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19107, United States
Author contributions: Romero-Gomez M was the guarantor of article; Ampuero J, Reddy KR and Romero-Gomez M wrote the paper; Ampuero J, Reddy KR and Romero-Gomez M contributed to the design of the review.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manuel Romero-Gomez, Full Professor, Head of Inter-Centre Unit of Digestive Diseases, Virgen Macarena, Virgen del Rocío University Hospitals, Av. Manuel Siurot, s/n, 41013 Sevilla, Spain. mromerogomez@us.es
Telephone: +34-955-012568 Fax: +34-955-015899
Received: February 10, 2016
Peer-review started: February 10, 2016
First decision: March 21, 2016
Revised: April 10, 2016
Accepted: May 4, 2016
Article in press: May 4, 2016
Published online: June 14, 2016
Processing time: 113 Days and 9.9 Hours
Abstract

AIM: To address the therapeutic efficacy of various treatment regimens in genotype 3 selecting randomized clinical trials and prospective National Cohort Studies.

METHODS: (1) PEG-INF-based therapy including sofosbuvir (SOF) + RBV for 12 wk vs SOF + RBV 24 wk; (2) SOF + RBV therapy 12 wk/16 wk vs 24 wk; and (3) the role of RBV in SOF + daclatasvir (DCV) and SOF + ledipasvir (LDV) combinations. This meta-analysis provides robust information with the intention of addressing treatment strategy for hepatitis C virus genotype 3.

RESULTS: A combination treatment including SOF + RBV + PEG-IFN for 12 wk notes better SVR than with only SOF + RBV for 12 wk, although its association with more frequent adverse effects may be a limiting factor. Longer duration therapy with SOF + RBV (24 wk) has achieved higher SVR rates than shorter durations (12 or 16 wk). SOF + LDV are not an ideal treatment for genotype 3.

CONCLUSION: Lastly, SOF + DCV combination is probably the best oral therapy option and the addition of RBV does not appear to be needed to increase SVR rates substantially.

Keywords: Hepatitis C; Genotype 3; Sofosbuvir; Daclatasvir; Ledipasvir

Core tip: The landscape of therapy for hepatitis C virus infection is changing rapidly. In genotype 3, the improvement in SVR rates has not been hugely spectacular, being considered the most difficult genotype to treat and representing a major challenge. The advent of direct acting antivirals has not solved all questions about the treatment, while challenges remain such as the use of RBV, the duration of PEG-IFN-free treatment and whether PEG-IFN still plays an important role. These questions are difficult to elucidate with the current data because of the small number of patients included in clinical trials (particularly, those with cirrhosis) and their different designs.