Journal of Hepatology
Volume 51, Issue 4 , Pages 675-681, October 2009

Retreatment with pegylated interferon plus ribavirin of chronic hepatitis C non-responders to interferon plus ribavirin: A meta-analysis☆

  • Calogero Cammà

      Affiliations

    • Cattedra di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
    • Institute of Biomedicine and Molecular Immunology, CNR Palermo, Palermo, Italy
    • Corresponding Author InformationCorresponding author. Tel.: +39 091 6552145; fax: +39 091 6552156.
    • ,
  • Giuseppe Cabibbo

      Affiliations

    • Cattedra di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
    • Dipartimento di Biopatologia e Metodologie Biomediche, University of Palermo, Palermo, Italy
    • ,
  • Fabrizio Bronte

      Affiliations

    • Cattedra di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
    • ,
  • Marco Enea

      Affiliations

    • Dipartimento di Scienze Statistiche e Matematiche, “S. Vianelli”, University of Palermo, Palermo, Italy
    • ,
  • Anna Licata

      Affiliations

    • Cattedra di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
    • ,
  • Massimo Attanasio

      Affiliations

    • Dipartimento di Scienze Statistiche e Matematiche, “S. Vianelli”, University of Palermo, Palermo, Italy
    • ,
  • Angelo Andriulli

      Affiliations

    • Divisione di Gastroenterologia, Casa Sollievo della Sofferenza, IRCCS Hospital San Giovanni Rotondo, San Giovanni Rotondo, FG, Italy
    • ,
  • Antonio Craxì

      Affiliations

    • Cattedra di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy

Received 9 April 2009; received in revised form 19 June 2009; accepted 22 June 2009. published online 15 July 2009.

Associate Editor: M. Colombo

Background/Aims

Efficacy of retreatment with pegylated interferon (PEG-IFN) plus ribavirin of non-responders to standard or pegylated IFN plus ribavirin has been assessed in various studies, but sustained virologic response (SVR) rates are variable and factors influencing efficacy and tolerability still remain incompletely defined. We aimed to focus on SVR rates and to identify factors influencing them in this meta-analysis.

Methods

MEDLINE as well as a manual search were used. Studies were included if they were controlled or uncontrolled trials, if they had been published as full-length papers and if they included non-responders to standard or pegylated IFN and ribavirin therapy. Fourteen trials were included in the meta-analysis. Data on study populations, interventions, and outcomes were extracted from trials using a random-effects model. Primary outcome was the SVR rate.

Results

The pooled estimate of SVR rate was 16.3% (95% Confidence Interval – 95% CI, 8.3–29.6%). There was a significant heterogeneity among studies (p<0.0001). Heterogeneity was less apparent in studies that included fewer patients with cirrhosis or overweight. By meta-regression, higher SVR rate was observed in trials with a lower prevalence of subjects with genotype 1 infection and with fewer overweight patients. The use of a 24-week retreatment stopping rule did not affect SVR rate.

Conclusions

The overall modest efficacy argues against an indiscriminate retreatment with PEG-IFN and ribavirin of all non-responders. Restricting retreatment to non-overweight patients or to those with genotype 2 or 3 infection, using a 24-week retreatment stopping rule, would optimize the potential benefit with a scarce likelihood of missing a curative response.

Abbreviations: HCV-RNA, hepatitis C virus ribonucleic acid, SVR, sustained virologic response, PEG-IFN, pegylated interferon, IFN, interferon, NR, non-responder, HCV, hepatitis C virus

Keywords: HCV, Interferon, Sustained virologic response, Ribavirin

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☆ The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

PII: S0168-8278(09)00457-7

doi:10.1016/j.jhep.2009.06.018

Journal of Hepatology
Volume 51, Issue 4 , Pages 675-681, October 2009

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