Optimal length of antiviral therapy in patients with hepatitis C virus genotypes 2 and 3: a meta-analysis

Current guidelines recommend a duration of 24 weeks of treatment with pegylated interferon and ribavirin for patients infected with chronic hepatitis C virus (HCV) genotypes 2 and 3. Several trials investigated whether shorter treatment duration is equally effective in achieving sustained virological response (SVR). Our aim was to determine the optimal length of treatment in patients with HCV genotypes 2 and 3.

Systematic literature identified eight randomized controlled trials (RCTs). Meta-analyses were carried out on SVR data from three studies randomized at baseline and five studies randomized at rapid virological response (RVR) to either 12-16 weeks or a 24-week course.

Pooled SVR data were higher in standard treatment in RCTs that randomized at baseline, with a relative risk (RR) of 0.88 (95% confidence interval [CI] 0.76-1.01). The pooled proportion of SVR rates of RCTs that randomized at RVR were similar in the short treatment group (82%) as in the standard treatment (83%), with the pooled effect given by a RR of 1.00 (95% CI 0.92-1.09).

A shorter course (12-16 weeks) of combination therapy does not impair efficacy compared with a 24-week course in HCV genotypes 2 and 3 patients who achieve an RVR. HCV patients without RVR should consider 24 weeks of treatment.