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Adding ribavirin to interferon increases the number of patients who clear hepatitis C virus but also leads to several adverse reactions

Globally about 170 million people are chronically infected with hepatitis C virus. Hepatitis C is a blood‐borne virus and routes of transmission include intravenous drug use, mother‐to‐infant transmission, unsafe medical practices, high‐risk sexual behavior, and blood transfusion. Chronic hepatitis C is in most patients a benign viral infection, but a minority of patients develop liver cirrhosis and may suffer from complications due to cirrhosis or die.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Peginterferon plus ribavirin is more effective than interferon plus ribavirin in clearing hepatitis C virus

Hepatitis C is a disease of the liver caused by the hepatitis C virus. Globally, an estimated 170 million people are chronically infected with the hepatitis C virus. Chronic hepatitis C can cause liver damage in the form of inflammation and scarring of the liver (cirrhosis). Liver damage can lead to liver failure and other complications, including liver cancer. The goal of treatment of chronic hepatitis C is to prevent complications of hepatitis C infection; this could possibly be achieved by clearing the virus from the blood of the patient (sustained virological response, that is, undetectable hepatitis C virus RNA in serum by sensitivity testing six months after the end of treatment). However, we still need to understand whether the sustained virological response outcome induced by antiviral treatment has any association with patient‐relevant and clinically relevant outcomes. A combination of weekly injections of peginterferon and oral ribavirin represents the current standard of care.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Treatment of patients infected with hepatitis C virus

Globally, about 170 million people are chronically infected with hepatitis C virus. Hepatitis C is a blood‐borne virus and routes of transmission include intravenous drug use, mother‐to‐infant transmission, unsafe medical practices, high‐risk sexual behaviour, and blood transfusion. Chronic hepatitis C is in most patients a benign viral infection, but a minority of patients develop liver cirrhosis and may suffer from complications due to cirrhosis or die from it.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Antiviral treatment for chronic hepatitis C in patients with HIV infection

End‐stage liver disease due to chronic hepatitis C is the leading cause of death among patients with stable HIV. The recommended treatment for chronic hepatitis C among patients without HIV is peginterferon plus ribavirin. Based on evidence from trials on HIV‐negative patients with hepatitis C, the viral genotype, dose of treatment and duration of therapy may affect the treatment response. This review is the first to evaluate the antiviral effect of peginterferon, ribavirin or amantadine administered in different combinations for a patient group, which has not previously been treated for hepatitis C. A total of 14 randomised clinical trials with at total of 2269 patients have been included in this review.The present review suggests that peginterferon plus ribavirin may also be considered if patients have HIV. The dose of peginterferon was similar to that assessed in trials on patients without HIV (180 microgram or 1.5 microgram/kg once weekly), but the dose of ribavirin was somewhat lower in most trials (800 mg daily). There were considerable differences between the trials possibly related to the dose and duration of treatment or the proportion of patients with different hepatitis C virus genotypes. The benefit of treatment was seen when assessing the proportion of patients with a sustained loss of the hepatitis C virus from the blood and the proportion with improved liver biopsies. No significant differences were seen in clinical outcome measures, including mortality (1%, irrespective of treatment). There were several adverse events. Fatal lactic acidosis and liver failure occurred. Other adverse events included anaemia and flu‐like symptoms that occurred more frequently among patients receiving peginterferon plus ribavirin. No significant differences were seen regarding the risk of depression, mortality, and progression to cirrhosis or to AIDS. Additional randomised trials are necessary to assess the effect in HIV and HCV co‐infected patients of peginterferon plus ribavirin in relation to the duration of therapy, especially in patients with hepatitis C genotype 2 or 3. Additional trials comparing peginterferon plus ribavirin versus interferon plus ribavirin or peginterferon alone do not seem warranted.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Comparing Pegylated Interferons for Hepatitis C

How do pegylated interferons compare in treating chronic hepatitis C?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: October 1, 2007

Antiviral therapy for recurrent liver graft infection with hepatitis C virus

The liver is an important organ of the body and has various functions including generation of energy from food; production of material necessary for congealing, processing, and excretion of drugs and waste products in blood; and filtering out the harmful bacteria that enter the body through the gut. Hepatitis C virus can cause damage to the liver usually in an insidious manner (chronic hepatitis C infection). Sometimes, the liver damage can be so severe that the liver is not able to carry out the normal functions, resulting in liver failure. Liver transplantation is an effective treatment for the treatment of liver failure due to chronic hepatitis C infection. However, liver transplantation does not eradicate the virus and the virus can affect the donor liver graft. One of the proposed strategies to treat the recurrence of chronic hepatitis C virus infection in these patients is using antiviral treatments. The effectiveness of these treatments is not known. We performed a detailed review of the medical literature (to February 2013) to determine the benefits and harms of different antiviral treatments for patients with recurrent hepatitis C infection after undergoing liver transplantation for chronic hepatitis C virus infection. We sought evidence from randomised clinical trials only. When conducted properly, such trials provide the best evidence. Two authors independently identified the trials and obtained the information from the trials to minimise error.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Chinese medicinal herbs for influenza

Influenza is a viral respiratory infection that causes an acute febrile illness with myalgia, headache and cough, and can result in high morbidity and mortality rates during an epidemic. Annual epidemics are thought to result in between three and five million cases of severe influenza and between 250,000 and 500,000 deaths worldwide. Currently, annual vaccination is the primary strategy for preventing influenza, and four influenza antiviral agents (amantadine, rimantadine, zanamivir and oseltamivir) have been approved for treatment of influenza. However, high levels of drug resistance have been recorded. Many Chinese medicinal herbs are used to treat and prevent this condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Extended treatment for 72 weeks versus standard treatment for 48 weeks in chronic hepatitis C genotype 1 infected slow responders

Chronic hepatitis C is a leading cause of liver‐related morbidity and mortality. The standard length of treatment with peginterferon plus ribavirin for hepatitis C virus genotype 1 infected patients is 48 weeks, but the number of patients who are treated successfully with regard to disappearance of the virus from the blood (sustained virological response) is limited. In order to improve it, extending the length of the treatment period has been suggested. We attempted to identify whether extending treatment duration to 72 weeks is better than the standard 48 weeks in a subgroup of patients who have shown a slow viral response.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antiviral therapy to prevent the recurrence of chronic hepatitis C infection in patients undergoing liver transplantation

The liver is an important organ of the body and has various functions including generation of energy from food, production of material necessary for congealing, processing and excretion of drugs and waste products in blood, and filtering out the harmful bacteria that enter the body through the gut. Hepatitis C virus can cause damage to the liver usually in an insidious manner (chronic hepatitis C virus infection). Sometimes, the liver damage can be so severe that the liver is not able to carry out the normal functions, which results in liver failure. Liver transplantation is effective in treating liver failure due to chronic hepatitis C infection. However, liver transplantation does not eradicate the virus and the virus can affect the donor liver graft. One of the proposed strategies to prevent the recurrence of chronic hepatitis C infection in these patients is to give drug treatment before the donor liver graft is affected by chronic hepatitis C infection. The effectiveness of these preventive treatments is not known. The review authors performed a detailed review of the medical literature to February 2013 to determine the benefits and harms of different preventive antiviral treatments for patients undergoing liver transplantation for chronic hepatitis C virus infection. The review authors sought evidence from randomised clinical trials only. When conducted properly, such trials provide the best evidence. Two review authors independently identified the trials and obtained the information from the trials to minimise error.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Treating Chronic Hepatitis C: A Review of the Research for Adults

This summary will discuss treatment options for chronic hepatitis C. It will tell you about research on how well medicines for chronic hepatitis C work. It will also tell you about research on the side effects of these medicines. It does not discuss screening and diagnosis of hepatitis C. This summary can help you talk with your doctor about which treatment might be best for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 27, 2012

Simeprevir (Olysio) for chronic hepatitis C: Overview

Simeprevir (trade name: Olysio) has been approved in Germany since May 2014 to treat chronic hepatitis C infections. It is taken along with other drugs as combination therapy. Treatment aims to stop the virus from reproducing and prevent hepatitis C complications.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 1, 2014

Chronic hepatitis C: What are the advantages and disadvantages of boceprevir (Victrelis)?: Boceprevir for people with chronic hepatitis C who have not been treated before

This text summarizes the effects of boceprevir for people with chronic hepatitis C who have not been treated before. IQWiG assessed trials that compared triple therapy consisting of boceprevir and the previous standard drugs peginterferon alfa and ribavirin, with dual standard therapy consisting only of peginterferon alfa and ribavirin.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 25, 2012

Chronic hepatitis C: What are the advantages and disadvantages of boceprevir (Victrelis)? Overview

Boceprevir was approved in mid-2011 for people infected with certain hepatitis C viruses. It is taken in addition to current standard therapy and aims to stop viruses from reproducing and thus prevent complications from hepatitis C.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 25, 2012

Chronic hepatitis C: What are the advantages and disadvantages of boceprevir (Victrelis)?: People with chronic hepatitis C who have not responded to previous treatment or who have had a recurrence

This text summarizes the effects of boceprvir for people with chronic hepatitis C who have not responded to previous treatment or who have had a recurrence. IQWiG assessed trials that compared triple therapy consisting of boceprevir and the previous standard drugs peginterferon alfa and ribavirin, with dual standard therapy consisting only of peginterferon alfa and ribavirin.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 25, 2012

Ledipasvir / sofosbuvir (Harvoni) for chronic hepatitis C: Ledipasvir / sofosbuvir (Harvoni) for hepatitis C (genotype 1) in people with liver cirrhosis who have had no previous treatment

In early 2015, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of ledipasvir / sofosbuvir compared with standard therapies for the treatment of hepatitis C infection.The following results apply to cases of chronic hepatitis C (genotype 1) in people with liver cirrhosis who have had no other previous treatment. The patients did not also have an HIV infection. For this group, IQWiG performed a historical comparison with data from a total of ten studies. One of these studies looked into treatment with ledipasvir / sofosbuvir, and the other nine examined the double combination of peginterferon alfa and ribavirin.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: March 2, 2015

Daclatasvir (Daklinza) for hepatitis C: Overview

Daclatasvir (trade name: Daklinza) has been approved in Germany since May 2014 for the treatment hepatitis C virus infections in adults. It is combined with other drugs to treat the virus. Treatment aims to stop the virus from multiplying and prevent complications of hepatitis C.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 19, 2015

Simeprevir (Olysio) for chronic hepatitis C: Simeprevir (Olysio) for hepatitis C (genotype 1) without previous treatment

In 2014, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed the advantages and disadvantages of simeprevir in combination with peginterferon and ribavirin for treating chronic hepatitis C compared with conventional therapies.The following results apply to people with chronic HCV infection with or without cirrhosis, who have not had any previous treatment and are not infected with HIV. Three studies compared treatment using simeprevir in combination with peginterferon alfa and ribavirin, with treatment using only peginterferon alfa and ribavirin.The results show that the following factors influence the effect of simeprevir:Q80K polymorphism: Simeprevir inhibits a protein that hepatitis C viruses need to reproduce reproduction. This protein may mutate, reducing the effectiveness of simeprevir. This mutation is referred to as Q80K polymorphism.IL28B genotype (CC or CT/TT): Interleukin-28B (IL28B) is a protein messenger used by the immune system to fight viruses. The body produces one of two variants of this messenger substance, referred to as genotypes CC and CT/TT. Studies show that people who have the CC variant may be able to fight off HCV better than people with the CT/TT variant.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 9, 2014

Simeprevir (Olysio) for chronic hepatitis C: Simeprevir (Olysio) for hepatitis C (genotype 1) for relapsed hepatitis C (genotype 1)

In 2014, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) assessed the advantages and disadvantages of simeprevir in combination with peginterferon and ribavirin for treating chronic hepatitis C compared with conventional therapies.The following results apply to people who have chronic HCV infection who experienced a relapse after an initially successful treatment and who were not infected with HIV. One study compared treatment using simeprevir in combination with peginterferon alfa and ribavirin, with treatment using only peginterferon alfa and ribavirin.The results of these studies show that the following factors can influence the effectiveness of simeprevir:HCV genotype 1a and 1b: There are 6 different main types of the hepatitis C virus, which can be further divided into 60 subtypes called genotypes. Different medications are not equally effective against the various genotypes. Genotype 1a is more prevalent in the U.S., while genotype 1b is more common in Europe, for example.Q80K polymorphism: Simeprevir inhibits a protein that hepatitis C viruses need to reproduce. This protein may mutate, making simeprevir less effective. This mutation is referred to as the Q80K polymorphism.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 9, 2014

Dasabuvir (Exviera) for hepatitis C: Dasabuvir (Exviera) for hepatitis C (genotype 1a) in adults who have had previous treatment and do not have liver cirrhosis

In early 2015, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of dasabuvir for people with hepatitis C compared with standard therapies. The following results apply to people who have a chronic HCV infection (genotype 1a) but do not have liver cirrhosis and have previously had unsuccessful treatment.The manufacturer provided one relevant study. One group of participants (19 people) took dasabuvir as part of a triple therapy, together with ribavirin and the combination drug ombitasvir / paritaprevir / ritonavir. Another group of participants (7 people) had standard therapy with peginterferon, ribavirin, and telaprevir. The results are described below.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 4, 2015

Dasabuvir (Exviera) for hepatitis C: Dasabuvir (Exviera) for hepatitis C (genotype 1a) in adults who have not had previous treatment and do not have liver cirrhosis

In early 2015, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of dasabuvir for people with hepatitis C compared with standard therapies. The following results apply to people who have a chronic HCV infection without cirrhosis and who have not had any previous treatment.The manufacturer provided one relevant study. One group of participants (69 people) took dasabuvir as part of a triple therapy together with ribavirin and the combination drug ombitasvir / paritaprevir / ritonavir. Another group (34 people) had standard therapy with peginterferon, ribavirin, and telaprevir. The results are described below.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 4, 2015

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