title: Comparative effectiveness of antiviral treatment for hepatitis C virus infection in adults: a systematic review.
abstract: BACKGROUND
  Multiple treatments are available for chronic hepatitis C virus (HCV) infection.
  
  
  OBJECTIVE
  To compare benefits and harms of antiviral regimens for chronic HCV infection in treatment-naive adults.
  
  
  METHODS
  English-language literature from MEDLINE (1947 to August 2012), the Cochrane Library Database, Embase, Scopus, PsychINFO, and clinical trial registries.
  
  
  METHODS
  Randomized trials of antiviral treatments and cohort studies examining associations between sustained virologic response (SVR) after therapy and clinical outcomes.
  
  
  METHODS
  Several investigators abstracted study details and quality by using predefined criteria.
  
  
  RESULTS
  No trial evaluated effectiveness of treatment on long-term clinical outcomes. Dual therapy with pegylated interferon alfa-2b plus ribavirin was associated with a lower likelihood of SVR than was pegylated interferon alfa-2a plus ribavirin (absolute difference, 8 percentage points [95% CI, 3 to 14 percentage points]) on the basis of 7 poor- to fair-quality trials. For genotype 2 or 3 infection, dual therapy for 12 to 16 weeks was associated with a lower likelihood of SVR than was therapy for 24 weeks, and lower doses of pegylated interferon alfa-2b were less effective than standard doses (2 to 4 fair-quality trials). For genotype 1 infection, fair-quality trials found that triple therapy with pegylated interferon, ribavirin, and either boceprevir (2 trials) or telaprevir (4 trials) was associated with a higher likelihood of SVR than was dual therapy (absolute difference, 22 to 31 percentage points). Compared with dual therapy, boceprevir triple therapy increased risk for hematologic adverse events and telaprevir triple therapy increased risk for anemia and rash. A large well-designed cohort study and 18 smaller cohort studies found that an SVR after antiviral therapy was associated with lower risk for all-cause mortality than was no SVR.
  
  
  CONCLUSIONS
  Trials involved highly selected populations. Observational studies did not always adequately control for confounders.
  
  
  CONCLUSIONS
  SVR rates for genotype 1 infection are higher with triple therapy that includes a protease inhibitor than with standard dual therapy. An SVR after antiviral therapy appears associated with improved clinical outcomes.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors: Oregon Health & Science University, Portland, USA. chour@ohsu.edu
authors: Roger
authors: R
authors: Chou
authors: Daniel
authors: D
authors: Hartung
authors: Basmah
authors: B
authors: Rahman
authors: Ngoc
authors: N
authors: Wasson
authors: Erika Barth
authors: EB
authors: Cottrell
authors: Rongwei
authors: R
authors: Fu
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a