July 24, 2017
Last month, the Cochrane Review published a controversial paper on HCV therapy that left many ID doctors and hepatologists perplexed.
After reviewing 138 randomized clinical trials using directly acting, non-interferon based therapies, they came to the following conclusions:
Anyone -- clinician, researcher, or patient -- who has experienced the miraculous advances in HCV therapy that started in 2014 could easily be scratching their heads at these conclusions.
The FDA might be surprised as well, since they have allowed SVR as an appropriate "surrogate" marker of the effectiveness of HCV therapy for some time.
Fortunately, we now have a focused, persuasive response by the IDSA, just published in Clinical Infectious Diseases.
I strongly encourage anyone who doubts the clinical benefits of curing HCV to read the full paper, but in essence the argument goes like this:
I will note that this isn't the first time a "systematic review" of an Infectious Disease treatment under the Cochrane name ended up with a surprising conclusion.
Remember this one on HIV treatment with TDF/FTC/efavirenz? The one which stated there was insufficient evidence to support its use, despite numerous randomized clinical trials documenting its efficacy? And its widespread adoption in clinical guidelines?
It may be hard to find today, since it was later withdrawn.
Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.
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