Meta-analysis: ribavirin plus interferon vs. interferon monotherapy for chronic hepatitic C - an updated Cochrane review
Meta-analysis: ribavirin plus interferon vs. interferon monotherapy for chronic hepatitic C - an updated Cochrane review
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DOI：
10.1111/j.1365-2036.2010.04423.x
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发表时间：
2010-10-01
影响因子：
7.6
通讯作者：
Gluud, C.
中科院分区：
文献类型：
--
作者：
Brok, J.;Gluud, L. -L.;Gluud, C.
目的对干扰素联合利巴韦林治疗慢性丙型肝炎的疗效进行Meta分析。方法将随机对照试验的结果进行累积Meta分析。试验序贯分析用于调整由于随机误差和多重性而产生的虚假结果。结果的措施是检测不到丙型肝炎病毒RNA血清（持续病毒学反应）和肝脏相关的发病率加上全因mortality.ResultsWe包括82项随机试验，12 615例。1998年，经过9项试验，试验序贯分析证实干扰素加利巴韦林与干扰素相比对持续病毒学应答有明显的有益作用（RR：0.74; 95%CI：0.64-0.85，P < 0.0001，1734例患者）。随后，发表了另外73项试验，只是缩小了置信区间并降低了P值。相比之下，试验序贯分析发现，需要更多的证据来令人信服地检测干扰素加利巴韦林与干扰素单药治疗对临床outcomes.ConclusionsThe背后的理由干扰素加利巴韦林治疗慢性丙型肝炎最近的几项试验的有益效果是值得商榷的病毒学反应的影响建立。需要更多的证据来评估干扰素加利巴韦林是否能改善临床结果。
P>BackgroundMultiple randomized trials have been published on antiviral treatment for chronic hepatitis C.AimTo meta-analyse the effect of adding ribavirin to interferon for chronic hepatitis C.MethodsThe results of randomized trials were combined in cumulative meta-analyses. Trial sequential analyses were used to adjust for spurious results because of random errors and multiplicity. The outcome measures were undetectable hepatitis C virus RNA in serum (sustained virological response) and liver-related morbidity plus all-cause mortality.ResultsWe included 82 randomized trials with 12 615 patients. Trial sequential analysis established clear beneficial effect of interferon plus ribavirin vs. interferon on the sustained virological response in 1998 after nine trials (RR: 0.74; 95% CI: 0.64-0.85, P < 0.0001, 1734 patients). Subsequently, additional 73 trials were published just narrowing the confidence interval and decreasing the P-value. By contrast, trial sequential analysis found that additional evidence is needed to convincingly detect a beneficial effect of interferon plus ribavirin vs. interferon monotherapy on clinical outcomes.ConclusionsThe rationale behind several recent trials on adding ribavirin to interferon for chronic hepatitis C is debatable as the effect on virological response is established. More evidence is needed to assess if adding ribavirin to interferon improves clinical outcomes.