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Experts question Cochrane review of hepatitis C treatment
Keith Alcorn, 2017-06-15 07:20:00

A systematic review of hepatitis C direct-acting antiviral studies published by the Cochrane Collaboration has been strongly criticised by doctors and advocates for its conclusion that there is no evidence that the expensive drugs prolong life or reduce liver-related disease in people who achieve a sustained virologic response to treatment – a cure, in current understanding.

Systematic reviews have become highly influential in health policy-making and the development of clinical guidelines. The reviewers carry out a systematic search for all published and unpublished scientific studies relevant to a scientific question, rate the quality of those studies and calculate the overall effect of an intervention or treatment. In particular, systematic reviews seek to minimise bias caused by poor study design, inadequate follow-up or incomplete publication of results. The Cochrane Collaboration has published numerous systematic reviews in all areas of medicine and its reviews are highly regarded.

The Cochrane Collaboration’s review of the impact of DAAs on mortality, morbidity and serious adverse events, published last week, identified 138 randomised trials with 25,232 participants. Fifty-seven of the trials looked at products that have either been discontinued or withdrawn from the market. Only eleven studies comprising follow-up on 2,996 people reported on mortality and morbidity; meta-analysis of these studies found no significant difference in outcomes in people who received DAAs or placebo. A grand total of 16 deaths were reported in these studies and the median follow-up time in these studies is not stated for this analysis (Table 1.1, p. 357).

The study also found no impact of DAAs by sub-groups such as people with cirrhosis or chronic kidney disease, by genotype, treatment history, interferon or ribavirin usage.

The review also looked at serious adverse events – both drug side-effects and other serious events such as liver decompensation – and found that in 43 studies, comprising follow-up on 15,587 people, there was no difference in the rate of serious adverse events between those who received DAAs and those who did not.