title: Systematic review: interferon-free regimens for patients with HCV-related Child C cirrhosis.
abstract: It is unclear whether the efficacy and long-term outcome of treating patients with hepatitis C virus (HCV)-positive cirrhosis with the new protease inhibitors will extend to those with Child C cirrhosis.
  
  
  
  To assess the effectiveness of the interferon-free regimens in Child C cirrhotic patients with HCV infection.
  
  
  
  A systematic Medline search was conducted to retrieve studies describing the treatment of Child C patients with direct-acting agents. Citations from identified studies were cross-referenced and abstracts from European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Disease (AASLD) meetings were checked. Extracted data were evaluated using a meta-analysis to calculate a weighted response rate.
  
  
  
  Seven full-text records and two conference abstracts were retained for analysis from the 649 records identified. Data from an Italian real-life trial were also interrogated. Information on treatment outcome was available for 228 of the 240 Child C patients evaluated in the 10 trials. Overall, the weighted mean sustained virological response (SVR12) was 74.9% (95% CI: 65.6-82.4%). Neither duration of treatment (24 or 12 weeks), nor addition of ribavirin influenced these rates. The weighted SVR12 was 65.4% (95% CI: 46.8-80.2) after sofosbuvir/simeprevir, 76.0% (95% CI: 54.4-89.3%) after sofosbuvir/daclatasvir and 83.0% (95% CI: 73.4-89.6) after sofosbuvir/ledipasvir. Some studies did not provide information on the rate of post-treatment relapse or functional improvement. However, in those studies that did provide such data, a relapse was documented in 12.1% of patients and an improvement of ≥2 points on the model for end-stage liver disease (MELD) score in 61.1% of patients.
  
  
  
  The improvement in MELD scores strongly suggests HCV-positive patients with Child C cirrhosis should be treated with these agents.
authors.affiliation: Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Guarino
authors.affiliation: Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Morisco
authors.affiliation: Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: M R
authors.initials: MR
authors.lastname: Valvano
authors.affiliation: Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: A M
authors.identifier: 0000-0003-2135-5209
authors.initials: AM
authors.lastname: Ippolito
authors.affiliation: Pharmacia Librandi, Cirò Marina, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Librandi
authors.affiliation: Pharmacia Tor Millina, Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Andriulli
authors.affiliation: Division of Internal Medicine and Clinical Immunology, San Martino Hospital, IRCCS, Genova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Greco
authors.affiliation: Division of Emergency Medicine, San Carlo Hospital, Potenza, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Amoruso
authors.affiliation: Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Iacobellis
authors.affiliation: Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Niro
authors.affiliation: Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Caporaso
authors.affiliation: Division of Gastroenterology, Casa Sollievo Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Andriulli
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007372:Interferons; D008103:Liver Cirrhosis / Q000188:drug therapy*; D011480:Protease Inhibitors / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors; D007372:Interferons