Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Hepatologists Challenge Cochrane on Hep C DAAs

Am J Gastroenterol; ePub 2017 Nov 14; Kwo, et al

The recent Cochrane review that concluded there is no evidence to show direct acting antiviral drugs (DAAs) improve clinical outcomes in hepatitis C is incorrect, according to 3 prominent hepatologists from Stanford University, Bon Secours Liver Institute, and North Shore Long Island Jewish Health Care System.

  • The Cochrane review admitted that DAAs have a powerful impact on sustained virologic response (SVR), but questioned whether this marker has any clinical relevance.
  • The experts challenged that position because all the trials that evaluated the benefits of DAAs did not address any of these clinical end points, including decompensation events such as ascites, encephalopathy, varices, the need for liver transplantation, and liver cancer.
  • To extrapolate from the existing studies that the drugs do not offer any clinical benefits when the trials were never designed to measure these outcomes is “outrageous,” say the editorialists.

Citation:

Kwo PY, Shiffman ML, Bernstein DE. The Cochrane Review conclusion for hepatitis C DAA therapies is wrong. [Published online ahead of print Nov 14, 2017]. Am J Gastroenterol. doi:10.1038/ajg.2017.420.