Efficacy of DAA-based Antiviral Therapies for HCV Patients with Chronic Kidney Disease: A Meta-analysis

Context: HCV infection in patients with chronic kidney disease (CKD) is important to be treated because it's associated with increased healthcare costs, utilization and is pertained with decrease in survival rate of HCV-infected patients who also have chronic kidney disease. Direct acting agents (DAAs) are novel form of treatment of HCV infection in patients with CKD. The aim of this study is meta-analysis and comparison of the efficacy of different regimen of DAAs used in the treatment of HCV in such patients. Objective: Hepatitis C is a liver disease caused by the hepatitis C virus, the virus can cause both acute and chronic hepatitis. Hepatitis C virus (HCV) is a known risk factor for chronic kidney disease (CKD) and end-stage renal disease (ESRD). HCV infection in CKD patients is also associated with increased healthcare costs and utilization, with further increases in those with ESRD. It should be also noted that survival among HCV-infected patients with chronic kidney disease without undertaking any treatment is low, various mechanisms such as increased liver-related mortality, low quality of life and high cardiovascular risk can explain this finding. The benefits of treatment may extend beyond the liver, with improvements in both cardiovascular and renal outcomes in patient with chronic kidney disease. Previously PEG-INTERFRON Based regimens have been used for treatment of CKD or ESRD Patients with chronic Hepatitis C but this treatment plan was associated with higher adverse effects and less efficacy. Nowadays new researches have shown the efficacy of the Direct Anti-Viral Agents (DAAs) In such patients. Data Sources: A systematic literature searches in PubMed, EMBASE, Web of Science, and Scopus motor searches was done. Virologic response at 12 weeks after the end of treatment (SVR12) was extract from the included studies. Finally, SVR12 rate with 95% confidence intervals (CI) were pool analyzed with random-effects model. Study Selection: Studies were included if they satisfied the following criteria: Participants being adult HCV patients with stage 3–5 CKD (age≥18 years), Interventions being DAA-based antiviral therapies, Outcomes being sustained virologic response at 12 weeks after the end of treatment (SVR12). Studies were excluded if having incomplete outcome data and had no sufficient data to calculate SVR12. Data Extraction: The methodological quality of included observational studies was assessed by three reviewers independently by using the Newcastle–Ottawa scale (NOS), which is usually used for observational studies in meta-analyses. Results: 20 studies comprising a total of 628 patients (from 20 studies) were included for our meta-analysis. The pooled analysis for SVR12 rate was 0.95 (95% Cl 0.92-0.96, I2= 0.00%), 0.92 (95% Cl 0.82-0.96 I2= 0.00%) and 0.95 (95% Cl 0.93-0.97, I2= 0.0%) for total population, sofosbuvir base treatment group and non sofosbuvir base treatment group.   Conclusion: DDAs have high efficacy in treatment of HCV in patient with CKD and it seems that there is no different between sofosbuvir versus non sofosbuvir based regimens for treatment of HCV infection in this patients.