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Updated: Jan 19, 2026
Author Spotlight: Evaluating the Adjuvant Efficacy and Safety of Angong Niuhuang Pill in Viral Encephalitis Treatment
Published on: April 19, 2024
New Direct-Acting Antivirals for the Treatment of Patients With Hepatitis C Virus Infection: A Systematic Review of
Valentina Pecoraro1,2, Rita Banzi2, Elisabetta Cariani1
1Unit of Laboratory Medicine, Ospedale Civile Sant'Agostino Estense, Modena, Italy.
Background:
New direct-acting antiviral agents (DAAs) approved for the treatment of patients infected by Hepatitis C virus (HCV) are well tolerated and increase sustained virological response (SVR) rate. We summarize current evidence on the efficacy and safety from comparative randomized controlled trials (RCTs) of DAAs.
Methods:
We systematically searched MEDLINE, Embase, Scopus, CENTRAL, and Lilacs as well as a list of reference literature. We included RCTs comparing DAAs with placebo or active control and reporting response rates and adverse events according to antiviral regimens. Risk ratios (RRs) were pooled as appropriate. We assessed the risk of bias of included studies and graded the quality of evidence according to the GRADE method.
Results:
We included 28 RCTs, enrolling more than 7000 patients. The quality of evidence was generally low. Twelve-week treatment with DAAs in naïve patients significantly increased SVR12 and SVR24 compared with placebo (RR 1.4, 95% CI 1.3-1.6; RR 1.5, 95% CI 1.4-1.6, respectively). This means that for every 1000 patients, 240 or 260 more patients experienced SVR12 or SVR24 if treated with any DAAs. We could not find RCTs assessing progression of liver disease or development of hepatocellular carcinoma. DAAs were not associated with higher incidence of serious adverse events or discontinuation due to adverse events.
Conclusions:
This systematic review confirms that new DAAs are more effective in inducing SVR than placebo. Outside clinical trials, in real word, HCV cure with DAA regimens occurs in less than 90% of patients, so further comparative evaluations are needed to establish their long-term effects.
Insights
New direct-acting antiviral agents (DAAs) significantly increase Hepatitis C virus (HCV) cure rates compared to placebo. While well-tolerated, real-world effectiveness suggests further research is needed for long-term outcomes.
Area of Science:
- Hepatology
- Infectious Diseases
- Pharmacology
Background:
- Direct-acting antiviral agents (DAAs) offer improved Hepatitis C virus (HCV) treatment.
- DAAs are generally well-tolerated and increase sustained virological response (SVR) rates.
Purpose of the Study:
- To systematically review the efficacy and safety of DAAs.
- To evaluate evidence from comparative randomized controlled trials (RCTs) of DAAs.
Main Methods:
- Systematic literature search across multiple databases (MEDLINE, Embase, Scopus, CENTRAL, Lilacs).
- Inclusion of RCTs comparing DAAs with placebo or active controls.
- Risk ratio pooling and GRADE assessment for evidence quality.
Main Results:
- 28 RCTs with over 7000 patients were included; evidence quality was generally low.
- DAA treatment significantly increased SVR12 and SVR24 rates compared to placebo in treatment-naïve patients.
- No increased incidence of serious adverse events or treatment discontinuation due to adverse events was observed.
Conclusions:
- New DAAs are more effective than placebo in achieving SVR.
- Real-world HCV cure rates with DAAs are below 90%, necessitating further comparative evaluations.
- Long-term effects of DAAs require additional study.
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