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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: January 20, 2010

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: February 28, 2014

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: January 20, 2010

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: March 28, 2013

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: December 4, 2013

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: September 12, 2012

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: October 7, 2009

We wanted to assess the effects of any treatment for nerve damage that occurs in hepatitis C virus (HCV) infection. We planned to use the evidence from randomized controlled trials (RCTs).

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

Version: December 20, 2014

Hepatitis C is a disease of the liver caused by the hepatitis C virus. Globally, an estimated 170 million people are chronically infected with 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 aim of the treatment for chronic hepatitis C is to prevent complications of hepatitis C infection. This might be achieved by clearing the virus from the blood of the patient. However, we still need to understand if clearance of virus from blood has any association with patient‐relevant and clinically‐relevant outcomes. A combination of weekly injections of peginterferon alpha and daily oral ribavirin still represents the standard of care for the majority of patients with chronic hepatitis C. Currently, there are two licensed products of peginterferon, peginterferon alpha‐2a and peginterferon alpha‐2b, on the market.

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

Version: February 28, 2014

Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV) which spreads from person to person through blood contact which is a result of sharing drug needles, and other items contaminated with blood. This virus remains in the body for a long time and can affect the liver causing its slow destruction or cirrhosis and liver cancer. Infected people may have weakness, nausea, jaundice and lose weight. On blood tests they may have increase in liver enzymes and bilirubin.

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

Version: August 19, 2015

Hepatitis C virus is mainly transmitted by contact with infected blood. Chronic hepatitis C infection affects around 3% of the world's population and progresses slowly. Most patients present without symptoms, or with symptoms like fatigue or liver‐related morbidity (illness). Frequently, the disease is discovered by coincidence because of abnormal laboratory results. Between 5% and 40% of all infected patients will develop severe liver damage, which can cause severe liver‐related morbidities and eventually death. Current treatment consists of pegylated interferon‐alpha plus ribavirin, and in some groups of patients these two agents are administered in combination with antiviral drugs such as telaprevir or boceprevir. It is then possible to eradicate the virus from the blood in at least 70% of patients with chronic hepatitis C, but the clinical effects are not known.

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

Version: May 3, 2014

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: December 2, 2013

Hepatitis C virus is mainly transmitted by contact to infected blood. Chronic hepatitis C infection affects around 3% of the world population and progresses slowly. Most patients present without symptoms, or with symptoms like fatigue or liver‐related morbidity. Frequently, the disease is discovered by coincidence because of abnormal laboratory results. Around 5% to 40% of all infected patients will develop severe liver damage which can cause severe liver‐related morbidities and eventually death. Current treatment consists of pegylated interferon‐alpha plus ribavirin and in some subgroups of patients these agents are combined with telaprevir or boceprevir, or other direct acting antivirals. In about 70% of patients with chronic hepatitis C, it is possible to eradicate the virus from the blood, but the clinical effects are not known. Aminoadamantanes (another group of antiviral drugs), mostly amantadine, have been tested in several clinical trials. The authors have previously systematically reviewed amantadine versus placebo or no intervention and found no significant effects of amantadine.

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

Version: June 17, 2014

In 2018, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of sofosbuvir and ribavirin in teenagers with hepatitis C who have not had treatment before in comparison with the standard treatment of peginterferon alfa and ribavirin. The manufacturer gave IQWiG one study that provided at least preliminary answers to some questions. This study was on treatment with sofosbuvir and ribavirin, but didn't compare it directly with another treatment. The results of this kind of study generally aren't very conclusive when used to compare different treatments. People with chronic hepatitis C can be divided into different groups based on the genotype of their virus, the stage of the disease, and their previous treatments. The study involved 41 teenagers with genotype 2 or 3 without cirrhosis of the liver who had not had treatment before. The teenagers received treatment for a period of 12 to 14 weeks. The following results were found:

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

Version: February 8, 2018

In 2014, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) has examined what advantages and disadvantages the combination of sofosbuvir with peginterferon and/or ribavirin offers in comparison with conventional standard treatments for hepatitis C in adults. The manufacturer provided one relevant study. In this study only the results of those patients could be analyzed whose inflammation of the liver was caused by genotype 2 of the hepatitis C virus. The group of about 140 patients had not been treated before. Half of the participants were given sofosbuvir and ribavirin for 12 weeks. The other half received a combination of peginterferon and ribavirin for 24 weeks. The following results were found:

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

Version: February 8, 2018

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

In 2018, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of sofosbuvir in combination with ribavirin for teenagers who have had treatment before compared with best supportive care (BSC). The manufacturer gave IQWiG one study that provided at least preliminary answers to some questions. The study looked into treatment with sofosbuvir and ribavirin, but didn't compare it directly with another treatment. The results of this kind of study generally aren't very conclusive when used to compare different treatments. But the researchers at IQWiG still used the study for the assessment because there's currently no evidence that any other treatments are as effective. People with chronic hepatitis C can be divided into different groups based on the genotype of their virus, the stage of the disease, and their previous treatments. The study involved 9 teenagers with genotype 3 without cirrhosis of the liver who had had treatment before. But it is safe to assume that results would be similar for teenagers with genotype 2 who have had treatment before. The teenagers received treatment for a period of 24 weeks. The following results were found:

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

Version: February 8, 2018

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

In 2016, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) wanted to find out whether the fixed-dose combination of sofosbuvir and velpatasvir has any advantages or disadvantages compared with standard treatments for chronic hepatitis C. The manufacturer provided one study looking into the advantages or disadvantages of this new fixed-dose combination in people with genotype 2, with or without compensated cirrhosis, compared with the standard treatment sofosbuvir and ribavirin. The study involved about 260 people who received treatment for 12 weeks. One half of them were given the fixed-dose combination sofosbuvir / velpatasvir, while the other half had the standard treatment sofosbuvir / ribavirin.

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

Version: November 3, 2016

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

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