Meta-analysis: antiviral treatment for hepatitis D

Summary Background There is no satisfactory treatment for patients with hepatitis D (HDV). Aim To evaluate treatment for HDV using meta‐analysis. Methods Medline, Scopus, Cochrane Library and ISI Web of Knowledge searches using the textwords ‘Hepatitis D’, ‘therapy’, “interferon”, “peginterferon”, “pegylated interferon”, “lamivudine”, “pegifn”, “ifn” and “Hepatitis D”, and s from major Gastroenterology/Liver meetings. Endpoints: end of treatment biochemical (biochemical EOT) and virological response (virological EOT), end of follow‐up virological response (EOFUP VR), histological improvement and intrahepatic HDAg clearance. Results We included randomised clinical trials (RCTs) comparing Group A: interferon‐A (IFNa) vs. no treatment (three RCTs, n ;= ;137 patients), Group B: low dose vs. high dose IFNa (two RCTs, n ;= ;60), Group C: IFNa ;+ ;lamivudine vs. IFNa (two RCTs, n ;= ;48) and Group D: pegylated IFNa (PEG‐IFNa) vs. other medications (two RCTs, n ;= ;157). Group A. IFNa was better for biochemical EOT [OR, 0.11 (95% CI, 0.04–0.2)] and virological EOT [OR, 0.08 (95% CI, 0.03–0.2)], but not for EOFUP VR. Group B. High dose IFNa was better for biochemical EOT [OR, 0.24 (95% CI,0.08–0.73)] and virological EOT [OR, 0.27 (95% CI, 0.1–0.74)]. Group C. There was a trend favouring histological improvement [OR, 2.9 (95% CI, 0.6–13.4)]. Group D. PEG‐IFNa was better for virological EOT [OR, 0.419 (95% CI, 0.18–0.974)], EOFUP VR [OR, 0.404 (95% CI, 0.189–0.866)] and improvement in necroinflammatory activity [OR, 0.308 (95% CI, 0.129–0.732)]. Conclusions Long‐term suppression of HDV RNA by IFNa is not maintained despite an end of treatment response; adding lamivudine is not beneficial. PEG‐IFNa is superior to other medications with respect to EOT and EOFUP. New RCTs should test combinations of PEG‐IFNa and newest antivirals.