Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis

Patrice Cacoub (1, 2, 3, 1) , Anne Claire Desbois (1, 3, 1) , Cloé Comarmond (1, 1, 3) , David Saadoun (1, 3, 1)

1 CHU Pitié-Salpêtrière [AP-HP]
2 SU FM - Sorbonne Université - Faculté de Médecine
3 I3 - Immunologie - Immunopathologie - Immunothérapie [CHU Pitié Salpêtrière]

BACKGROUND AND AIMS: Extrahepatic manifestations of HCV are responsible for morbidity and mortality in many chronically infected patients. New, interferon-free antiviral treatment regimens, which present the opportunity to treat all HCV-infected patients, call for a better understanding of the benefits of treating non-cirrhotic chronically infected individuals. METHODS: A systematic review was conducted. Identified studies from targeted database searches on Embase and Medline were screened. The methodological quality of the included publications was evaluated. Random-effect model meta-analyses were performed. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: Data were extracted from a total of 48 identified studies. Achieving sustained virological response (SVR) was associated with reduced extrahepatic mortality (vs no SVR, OR 0.44 (95% CI 0.28 to 0.67)). SVR was associated with higher complete remissions in patients with cryoglobulinemia vasculitis (OR 20.76 (6.73 to 64.05)) and a higher objective response in those with malignant B-cell lymphoproliferative diseases (OR 6.49 (2.02 to 20.85)). Achieving SVR was also associated with reduced insulin resistance at follow-up (OR 0.42 (0.33 to 0.53)) and a significant protective effect on the incidence of diabetes (OR 0.34 (0.21 to 0.56)). Lack of randomised data comparing SVR versus non-SVR patients for the relevant extrahepatic indications attenuated these analyses. CONCLUSION: Antiviral therapy can reduce extrahepatic manifestations related to HCV when SVR is achieved. Higher quality data, and reporting over longer follow-up periods, will be required to thoroughly explore comprehensive HCV treatment strategies.

Mots clés: antiviral therapy; extrahepatic manifestations; hepatitis C; meta-analysis

Domaines: Maladies infectieuses; Hépatologie et Gastroentérologie; Santé publique et épidémiologie

Patrice Cacoub, Anne Claire Desbois, Cloé Comarmond, David Saadoun. Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis. Gut, 2018, 67 (11), pp.2025-2034. ⟨10.1136/gutjnl-2018-316234⟩. ⟨hal-01960761⟩