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Our analyses indicated that ribavirin significantly increases SVR [sustained viral response] rates and should be considered, if tolerated, added Floor A.C. Berden, MD, of Radboud University Medical Center, Nijmegen, the Netherlands, and her associates. Direct-acting antiviral regimens successfully treat chronic HCV infection, but tend to perform suboptimally in HCV GT3, especially when patients are treatment experienced and have cirrhosis. Options for HCV GT3 infection include sofosbuvir combined with ribavirin, daclatasvir, or velpatasvir. But head-to-head trials of these regimens are lacking, and are unlikely to occur, in part because the Food and Drug Administration permits single-arm trials with historical controls as the comparator, the investigators said. Therefore, they searched PubMed, Embase, and the Web of Science database through March 15, 2019, for randomized trials and real-world studies of at least one direct-acting antiviral agent in adults with chronic HCV GT3 infection.
They also manually searched abstracts presented at the 2015 conferences of the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. This work yielded 2020 studies: 16 randomized controlled trials, 6 single-arm studies, and 5 observational cohort studies. The researchers used a Bayesian analysis based on Markov chain Monte Carlo methods. For patients without cirrhosis, sofosbuvir and velpatasvir with ribavirin yielded the highest estimated likelihood of SVR (99% 95% confidence interval, 98%-100%) 2021, followed by sofosbuvir and velpatasvir without ribavirin (97% 95% CI, 95%-99%), sofosbuvir and daclatasvir with ribavirin (96% 95% CI.
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