Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis

• Published in: Gut Vol. 67; no. 11; pp. 2025 - 2034
• Main Authors: Cacoub, Patrice, Desbois, Anne Claire, Comarmond, Cloe, Saadoun, David
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2018; BMJ Publishing Group
• Subjects: Antiviral agents; Beta cells; Bias; Cryoglobulinemia; Diabetes mellitus; Hepatitis C; Human health and pathology; Hépatology and Gastroenterology; Immunoproliferative diseases; Infectious diseases; Insulin; Interferon; Life Sciences; Liver cancer; Lymphocytes; Meta-analysis; Morbidity; Mortality; Patients; Santé publique et épidémiologie; Systematic review; Vasculitis; France; extrahepatic manifestations; meta-analysis; hepatitis C; antiviral therapy
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gutjnl-2018-316234

Background and aimsExtrahepatic manifestations of HCV are responsible for morbidity and mortality in many chronically infected patients. New, interferon-free antiviral treatment regimens, which present the opportunity to treat all HCV-infected patients, call for a better understanding of the benefits of treating non-cirrhotic chronically infected individuals.MethodsA systematic review was conducted. Identified studies from targeted database searches on Embase and Medline were screened. The methodological quality of the included publications was evaluated. Random-effect model meta-analyses were performed. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsData were extracted from a total of 48 identified studies. Achieving sustained virological response (SVR) was associated with reduced extrahepatic mortality (vs no SVR, OR 0.44 (95% CI 0.28 to 0.67)). SVR was associated with higher complete remissions in patients with cryoglobulinemia vasculitis (OR 20.76 (6.73 to 64.05)) and a higher objective response in those with malignant B-cell lymphoproliferative diseases (OR 6.49 (2.02 to 20.85)). Achieving SVR was also associated with reduced insulin resistance at follow-up (OR 0.42 (0.33 to 0.53)) and a significant protective effect on the incidence of diabetes (OR 0.34 (0.21 to 0.56)). Lack of randomised data comparing SVR versus non-SVR patients for the relevant extrahepatic indications attenuated these analyses.ConclusionAntiviral therapy can reduce extrahepatic manifestations related to HCV when SVR is achieved. Higher quality data, and reporting over longer follow-up periods, will be required to thoroughly explore comprehensive HCV treatment strategies.