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Treatment of hepatitis C in children: a systematic review.

Hu J, Doucette K, Hartling L, Tjosvold L, Robinson J - PLoS ONE (2010)

Bottom Line: There are however few published studies which assess the efficacy and safety of HCV therapy in children.Adverse effects were primarily flu-like symptoms and neutropenia.Further research is needed to define the optimal therapy for HCV in children.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada. jr3@ualberta.ca

ABSTRACT

Background: Current guidelines recommend children be treated for hepatitis C virus (HCV) using the same principles applied in adults. There are however few published studies which assess the efficacy and safety of HCV therapy in children.

Methodology/principal findings: A systematic review of the literature was completed for studies of any design that evaluated HCV therapy in children. The primary outcome was sustained virologic response (SVR), with sub-group analysis of response rates by genotype. There were 4 randomized controlled trials (RCTs) and 31 non-randomized studies, all involving interferon, pegylated interferon (PEG-IFN), or combinations of these drugs with ribavirin. The SVR rate could not be directly compared as the populations and interventions differed across studies. Genotype was not reported or differed substantially from study to study. The overall SVR rate for PEG-IFN and ribavirin ranged from 30 to 100% which is comparable to the rate in adults. Similar to adults, the SVR rates were significantly higher in children with genotype 2 or 3 compared to genotype 1. Adverse effects were primarily flu-like symptoms and neutropenia. There were insufficient data to assess the applicability of the week 12 stop rule (stopping therapy at week 12 if there is less than a 2 log drop in HCV RNA) or the efficacy of shortening therapy to 24 weeks in children with genotype 2 and 3.

Conclusions/significance: Current guidelines for the treatment of HCV in children are based on limited data. Further research is needed to define the optimal therapy for HCV in children.

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Related in: MedlinePlus

SVR by genotype of PEG-IFN/ribavirin therapy in non-randomized studies.Note all patients in the Hasan study were infected with genotype 4 and genotype 1 vs. non-genotype 1 SVR was not reported for the Pawlowska and Sokal studies.
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pone-0011542-g004: SVR by genotype of PEG-IFN/ribavirin therapy in non-randomized studies.Note all patients in the Hasan study were infected with genotype 4 and genotype 1 vs. non-genotype 1 SVR was not reported for the Pawlowska and Sokal studies.

Mentions: Among the 16 interferon monotherapy therapy groups, SVR ranged from 0% to 76% (median: 37%) with 122 of 342 children (36%) achieving SVR (Figure 2). In the only study of PEG-IFN monotherapy, 6 of 14 children (43%) achieved SVR [24]. Among the 6 interferon/ribavarin combination therapy groups, SVR ranged from 27% to 64% (median: 48%) with 109 of 233 children (49%) achieving SVR (Figure 3). Among the 9 PEG-IFN/ribavarin combination therapy groups, SVR ranged from 30% to 100% (median: 63%) with 341 of 493 children (69%) achieving SVR (Figure 4).


Treatment of hepatitis C in children: a systematic review.

Hu J, Doucette K, Hartling L, Tjosvold L, Robinson J - PLoS ONE (2010)

SVR by genotype of PEG-IFN/ribavirin therapy in non-randomized studies.Note all patients in the Hasan study were infected with genotype 4 and genotype 1 vs. non-genotype 1 SVR was not reported for the Pawlowska and Sokal studies.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2903479&req=5

pone-0011542-g004: SVR by genotype of PEG-IFN/ribavirin therapy in non-randomized studies.Note all patients in the Hasan study were infected with genotype 4 and genotype 1 vs. non-genotype 1 SVR was not reported for the Pawlowska and Sokal studies.
Mentions: Among the 16 interferon monotherapy therapy groups, SVR ranged from 0% to 76% (median: 37%) with 122 of 342 children (36%) achieving SVR (Figure 2). In the only study of PEG-IFN monotherapy, 6 of 14 children (43%) achieved SVR [24]. Among the 6 interferon/ribavarin combination therapy groups, SVR ranged from 27% to 64% (median: 48%) with 109 of 233 children (49%) achieving SVR (Figure 3). Among the 9 PEG-IFN/ribavarin combination therapy groups, SVR ranged from 30% to 100% (median: 63%) with 341 of 493 children (69%) achieving SVR (Figure 4).

Bottom Line: There are however few published studies which assess the efficacy and safety of HCV therapy in children.Adverse effects were primarily flu-like symptoms and neutropenia.Further research is needed to define the optimal therapy for HCV in children.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of Alberta, Edmonton, Canada. jr3@ualberta.ca

ABSTRACT

Background: Current guidelines recommend children be treated for hepatitis C virus (HCV) using the same principles applied in adults. There are however few published studies which assess the efficacy and safety of HCV therapy in children.

Methodology/principal findings: A systematic review of the literature was completed for studies of any design that evaluated HCV therapy in children. The primary outcome was sustained virologic response (SVR), with sub-group analysis of response rates by genotype. There were 4 randomized controlled trials (RCTs) and 31 non-randomized studies, all involving interferon, pegylated interferon (PEG-IFN), or combinations of these drugs with ribavirin. The SVR rate could not be directly compared as the populations and interventions differed across studies. Genotype was not reported or differed substantially from study to study. The overall SVR rate for PEG-IFN and ribavirin ranged from 30 to 100% which is comparable to the rate in adults. Similar to adults, the SVR rates were significantly higher in children with genotype 2 or 3 compared to genotype 1. Adverse effects were primarily flu-like symptoms and neutropenia. There were insufficient data to assess the applicability of the week 12 stop rule (stopping therapy at week 12 if there is less than a 2 log drop in HCV RNA) or the efficacy of shortening therapy to 24 weeks in children with genotype 2 and 3.

Conclusions/significance: Current guidelines for the treatment of HCV in children are based on limited data. Further research is needed to define the optimal therapy for HCV in children.

Show MeSH
Related in: MedlinePlus