Treatment extension benefits HCV genotype I patients without rapid virological response: a systematic review

Background: Current guidelines recommend 48 weeks of treatment with pegylated interferon and ribavirin for patients infected with chronic hepatitis C virus (HCV) genotype I. Several clinical trials have investigated the efficacy of treatment duration longer than 48 weeks, but yielded discordant results. Methods: We performed a structured search of PubMed, Web of Science and the Cochrane library to identify randomised clinical trials in HCV genotype I patients who were treated either for 48 or 72 weeks. Sustained viral response (SVR) data were pooled and a sample size weighted pooled proportion was calculated. Results: We identified five studies matching our criteria. Studies randomised at baseline (n=I), at absence of rapid virological response (RVR) at week 4 (n=I), at early virological response at week 12 (EVR) (n=I) or at slow response at week 24 (n=2). In the RCT that randomised at absence of RVR, SVR was significantly higher in the extended treatment arm (57 vs 42%, p=0.02) with an RR of 1.35 (95% CI 1.04 to 1.75). This tendency was also observed in the studies that randomised at slow response (44 vs 35%), although no longer statistically significantly different. Conclusion: Prolonged 72-week treatment should be considered in HCV genotype I patients without RV R at week 4, as this increased SVR