Chander Geetanjali, Sulkowski Mark S, Jenckes Mollie W, Torbenson Michael S, Herlong H Franklin, Bass Eric B, Gebo Kelly A
Department of Medicine and Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Hepatology. 2002 Nov;36(5 Suppl 1):S135-44. doi: 10.1053/jhep.2002.37146.
This systematic review addressed 3 issues regarding current treatments for chronic hepatitis C: (1) efficacy and safety in treatment-naive patients; (2) efficacy and safety in selected subgroups of patients; and (3) effects on long-term clinical outcomes. Electronic databases were searched for articles from January 1996 to March 2002. Additional articles were identified by searching references in pertinent articles and recent journals and by questioning experts. Articles were eligible for review if they reported original human data from a study that used virological, histological, or clinical outcome measures. For data collection, paired reviewers assessed the quality of each study and abstracted data. This systematic review found that the combination of high-dose peginterferon and ribavirin was more efficacious than standard interferon and ribavirin in persons infected with hepatitis C virus (HCV) genotype 1 (sustained virologic response [SVR] rate: 42% vs. 33%) and that ranges of SVR rates were higher with peginterferon than standard interferon monotherapy in naïve patients (10% to 39% vs. 3% to 19%). Reports were consistent in showing treatment with interferon and ribavirin was more efficacious than interferon monotherapy in treatment-naive persons and previous nonresponders and relapsers. Studies were moderately consistent in showing that treatment decreases the risk for hepatocellular carcinoma (HCC). The evidence on treatment in important subgroups was limited by a lack of randomized controlled trials. Thus, the combination of peginterferon and ribavirin was the most efficacious treatment in patients with HCV genotype 1. Long-term outcomes were improved in patients with hepatitis C who achieved an SVR with treatment.
本系统评价探讨了当前慢性丙型肝炎治疗的3个问题:(1)初治患者的疗效和安全性;(2)特定亚组患者的疗效和安全性;(3)对长期临床结局的影响。检索了1996年1月至2002年3月电子数据库中的文章。通过检索相关文章和近期期刊的参考文献以及咨询专家,确定了其他文章。如果文章报告了使用病毒学、组织学或临床结局指标的研究中的原始人体数据,则符合纳入综述的标准。为收集数据,由两名评审员评估每项研究的质量并提取数据。本系统评价发现,高剂量聚乙二醇干扰素和利巴韦林联合治疗在丙型肝炎病毒(HCV)1型感染者中比标准干扰素和利巴韦林更有效(持续病毒学应答[SVR]率:42%对33%),并且在初治患者中,聚乙二醇干扰素的SVR率范围高于标准干扰素单药治疗(10%至39%对3%至19%)。报告一致显示,在初治患者以及既往无应答者和复发者中,干扰素和利巴韦林联合治疗比干扰素单药治疗更有效。研究在一定程度上一致表明,治疗可降低肝细胞癌(HCC)的风险。重要亚组治疗的证据因缺乏随机对照试验而有限。因此,聚乙二醇干扰素和利巴韦林联合治疗是HCV 1型患者中最有效的治疗方法。丙型肝炎患者经治疗获得SVR后,长期结局得到改善。