Combined treatment of HCV infection: is there a need for meta-analysis?

Background/Aims. The aim of this study was to estabilish the 'true' therape utical gain of a combined therapy interferon - ribavirin versus interferon monotherapy in hepatitis C virus infection. Methods. A systematic review of published trials comparing combined treatme nt (interferon + ribavirin) vs interferon monotherapy, was performed on art icles printed from 1991 to 1999. Results. The meta-analysis of retrieved trials showed that ribavirin signif icantly enhances the sustained response rate to interferon therapy in all t ypes of patients. The results of almost all studies were homogeneous: combi ned therapy approximately doubles response rates compared to interferon mon otherapy. At the end of the treatment, ribavirin increased the rate of vira l clearance approximately 22% and the biochemical response of about 31%. Th e net gain was about 24% for both viral and biochemical response rate after 24 weeks of follow-up. Conclusion. Combined therapy showed a significantly higher efficacy in term s of sustained negativity of viral genome in all classes of patients (naive s, relapsers, non-responders) becoming the therapy of choice. Nevertheless, more than about 50% of patients infected by hepatitis C virus show no sust ained response to treatment. The whole weight of final data is beared by th e major trials all with similar results, (C) 2000 Elsevier Science B.V. All rights reserved.