title: Treatment extension benefits HCV genotype 1 patients without rapid virological response: a systematic review.
abstract: BACKGROUND
  Current guidelines recommend 48 weeks of treatment with pegylated interferon and ribavirin for patients infected with chronic hepatitis C virus (HCV) genotype 1. Several clinical trials have investigated the efficacy of treatment duration longer than 48 weeks, but yielded discordant results.
  
  
  METHODS
  We performed a structured search of PubMed, Web of Science and the Cochrane library to identify randomised clinical trials in HCV genotype 1 patients who were treated either for 48 or 72 weeks. Sustained viral response (SVR) data were pooled and a sample size weighted pooled proportion was calculated.
  
  
  RESULTS
  We identified five studies matching our criteria. Studies randomised at baseline (n=1), at absence of rapid virological response (RVR) at week 4 (n=1), at early virological response at week 12 (EVR) (n=1) or at slow response at week 24 (n=2). In the RCT that randomised at absence of RVR, SVR was significantly higher in the extended treatment arm (57 vs 42%, p=0.02) with an RR of 1.35 (95% CI 1.04 to 1.75). This tendency was also observed in the studies that randomised at slow response (44 vs 35%), although no longer statistically significantly different.
  
  
  CONCLUSIONS
  Prolonged 72-week treatment should be considered in HCV genotype 1 patients without RVR at week 4, as this increased SVR.
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: T J G
authors.initials: TJ
authors.lastname: Gevers
authors.forename: S
authors.initials: S
authors.lastname: Slavenburg
authors.forename: M G H
authors.initials: MG
authors.lastname: van Oijen
authors.forename: J P H
authors.initials: JP
authors.lastname: Drenth
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D004359:Drug Therapy, Combination; D005838:Genotype; D006526:Hepatitis C / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a