Citation:

Xue W, Liu K, Qiu K, Shen Y, Pan Z, Hu P, Peng M, Chen M, Ren H. A systematic review with meta-analysis: Is ribavirin necessary in sofosbuvir-based direct-acting antiviral therapies for patients with HCV recurrence after liver transplantation? Int J Infect Dis. 2019 Jun;83:56-63. doi: 10.1016/j.ijid.2019.03.038. Epub 2019 Apr 5. PMID: 30959250.

Title: A Systematic review with meta-analysis: is ribavirin necessary in sofosbuvir-based direct-acting antiviral therapies for patients with HCV recurrence after liver transplantation?

Journal: International Journal of infectious diseases

Date of Publication: April 5, 2019

First author: Wei Xue

I chose to present this article together with my case presentation of a 69-year-old female admitted for acute abdomen workup with a comorbidity of HCV cirrhosis requiring a liver transplant (LT) 9 years ago. I was interested in further research on liver transplants and on uptodate I found that HCV cirrhosis often recurs after a LT. This article is a systematic review and meta-analysis that aimed to evaluate whether ribavirin (RBV) should be added to sofosbuvir (SOF)-based direct acting antiviral agents (DAAs) for patients with HCV recurrence after a LT. They searched articles in pubmed, web of science, Cochrane Library and EMBASE. They chose studies that included HCV recurrence in patients post LT who were treated with SOF-based DAAS +/- RBV and evaluated the sustained virological response (SVR) at 12 weeks. SVR means that HCV is not detected in the blood.

A total of 12 studies with 1466 participants were included. The SVR at 12 weeks was 91%. There was no statistical significance between SVR 12 in patients with SOF-based DAAs + RBV versus the group with no RBV. There was a higher tendency toward anemia in patients treated with RBV. They concluded that the addition of RBV does not contribute to a higher SVR rate at 12 weeks but increases the incidence of anemia, and therefore RBV is not necessary to be added to SOF-based DAAs for patients with HCV recurrence after LT.

They acknowledged the limitations in their study to be that there was only one RCT included in the study, and therefore this is not the highest level of evidence type of meta analysis, since meta analysis based on RCTs has a much higher level of evidence. Most of the studies included were observational studies due to the nature of the patients being unstable and unfit for RCTs. The addition of RBV to treatment was determined by the physicians treating the patients which can be a bias to the study. Furthermore they did not have enough evidence to analyze therapeutic effects of different genotypes of HCV.

This entry is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license.