A Systematic Review of Interferon Free Treatment Regimens for Hepatitis C Virus Genotype 1

The purpose of the systematic review was to identify and summarize the available evidence for achievement of sustained virologic response (SVR) among the treatment options currently available for infection with hepatitis C virus (HCV) genotype 1. ^ Following the suggested method for a systematic review from the Cochrane Collaboration, a PICO (Participants, Interventions and Comparisons, Outcomes) search strategy was performed using the UT Health Science Center Library database. Predetermined eligibility criteria permitted the inclusion and exclusion of articles at three screening levels: title, abstract, and full text. Data from included articles was extracted and synthesized into summary tables. A risk of bias assessment was performed on all included studies. ^ Using the PRISMA guidelines, 1,609 articles were retrieved from the initial database search. After duplicates were removed, 1,047 articles underwent a title screen, 386 articles met inclusion criteria and underwent an abstract screen, and 55 underwent the full text screen. Fifteen articles met inclusion criteria after the final round of screening and an additional two articles were retrieved following a reference review, providing 17 full articles for the literature review. Overall, the quality of the included studies was strong based on the risk of bias assessment. There was minimal selection bias, detection bias, attrition bias, reporting bias or ‘other bias’. However, there was a moderate to high risk of both selection bias due to lack of the allocation of concealment for researchers, and performance bias. ^ SVR rates were greater than 90% for interferon free treatment regimens in most studies, representing an increase of approximately 20% in SVR rates compared with the historical control treatment with telaprevir plus pegylated interferon with ribavirin (TPV/PR). The relative efficacy ratios for the oral direct acting antiviral (DAA) regimens were associated with an approximate 1.72 times greater likelihood of achieving SVR when compared to pegylated interferon plus ribavirin (PR). Compared to TPV/PR, all oral DAA regimens were associated with an approximate 1.44 times increase in the likelihood of achieving SVR. ^ Treatment of infected individuals leading to successful sustained virologic responses acts as a preventative measure by lowering the prevalence of HCV in populations and limiting the probability of spreading the disease to others. All treatment procedures for HCV genotype 1 infection (subtypes a and b) should halt the use of PR and TPV/PR and switch completely to treatment regiments with second generation DAAs.