A Systematic Review And Meta--analysis:Sofosbuvir--based Regimens Combined With Ribavirin For Patients With Genotype 1 Hepatitis C After Liver Transplantation

Objective: To evaluate the necessity of ribavirin(RBV)with sofosbuvir-based direct-acting antiviral agents(SOF-based DAAs)for recipients with hepatitis C virus genotype 1(HCV-GT1)after liver transplantation by performing a systematic review and meta-analysis.Methods: Pub Med,Web of Science,Cochrane Library,EMBASE,CBM,CNKI and Wan Fang databases were searched.We chose the studies that included patients with HCV-GT1 after liver transplantation who were divided into two groups: SOF-based DAAs+RBV and SOF-based DAAs,and evaluated the rate of sustained virological response 12 weeks(SVR12)after the end of treatment.Two reviewers independently screened,appraised quality,and extracted data.Data analysis was performed by R3.4.3 and Rev Man5.3 software.Results: A total of 445 patients with HCV-GT1 after liver transplantation in 6 studies were included in the meta-analysis.The overall rate of SVR12 in SOF-based DAAs±RBV was 90%(95% CI: 87%~92%).There was no statistically significant difference in the rate of SVR12 between the SOF-based DAAs+RBV group and the SOF-based DAAs group(RR=0.96,95% CI: 0.89~1.04,P=0.28),whereas the incidence of anemia in the SOF-based DAAs+RBV group was significantly higher than in the SOF-based DAAs group(RR=6.69,95%CI: 3.89~11.50,P <0.01).There was no statistically significant difference in the incidence of fatigue(RR=0.93,95%CI: 0.51~1.70,P=0.81),headache(RR=1.57,95%CI: 0.91~2.69,P=0.11),nausea/vomiting(RR=1.30,95%CI: 0.68~2.48,P=0.42)or pruritus/rash(RR=1.74,95%CI: 0.46~6.68,P=0.42)between the SOF-based DAAs+RBV group and the SOF-based DAAs group.There was no statistically significant difference of the rate of SVR12 between HCV-GT1a and HCV-GT1b(RR=0.95,95%CI: 0.86~1.05,P=0.33).There was no statistically significant difference in the efficacy between HCV-GT1 patients with cirrhosis and without cirrhosis after liver transplantation(RR=1.07,95%CI: 0.99~1.16,P=0.10).There was no statistically significant difference in the efficacy between the naive and experienced treatment of HCV-GT1 patients after liver transplantation(RR=1.00,95%CI: 0.92~1.10,P=0.93).There was no statistically significant difference in the efficacy between the 12 weeks and 24 weeks regimen of HCV-GT1 patients after liver transplantation(RR=1.00,95%CI: 0.91~1.10,P=0.95)Conclusions: The addition of RBV does not increase the rate of SVR12,but increases the incidence of anemia.Therefore,RBV is not recommended to combine with SOF-based DAAs for patients with HCV-GT1 after liver transplantation.