The Efficacy And Safety Of Direct-acting Antivirals Drugs In Children And Adolescents With Chronic Hepatitis C Virus Infection:A Meta-analysis

Background:At present,the treatment of chronic hepatitis C(CHC)has entered the era of Direct-Acting Antivirals Drugs(DAAs).Except for those with a short life expectancy which cannot be cured by anti-HCV therapy,it is recommended that chronic HCV-infected patients receive anti-hepatitis C virus treatment.However,there is a significant lag in the treatment of DAAs in children and adolescents,and global consensus on the treatment of Chronic Hepatitis C patients aged 3-12 years has not been fully harmonized.Objective: To evaluate the efficacy and safety of DAAs use in pediatric and adolescent patients with Chronic Hepatitis C,and to provide clinicians with more adequate evidence-based evidence for the rational use of direct-acting antivirals.Methods: By searching Pub Med,Embase,Cochrane Library,and Web of Science databases for studies using DAAs for the treatment of HCV in children or adolescents since the establishment of the database until December 31,2021,the full text of the literature was carefully read again by reading the titles and abstracts of the literature to quickly eliminate those that did not meet the criteria.The final included literature was screened for quality assessment using the MINORS entry score,and relevant data were extracted for statistical analysis using R-Studio software,with the rate of sustained virological response(SVR)at week 12 after the end of treatment as an indicator of efficacy and the ratio of the number of people producing at least one adverse event to the corresponding total number of people as an indicator of safety.Results: A total of 37 literatures with 1995 patients were included,there were 1167 male patients and 828 female patients.77.3% were treatment-native patients(n=1543),1468 patients in the adolescent group(mean age ≥12 years),and 527 patients in the pediatric group(mean age<12 years).The percentage of patients who completed treatment and achieved SVR was 99%(95% confidence interval: 98.3%-99.5%).The SVR of Genotype 1(GT1)was 99.1%(612 / 621),and that of GT2,GT3 and GT4 were 98.4%(48 / 49),97.6%(278 / 290)and 99.3%(818 / 828),respectively.The SVR rate of unclear genotype was 98.2%(201 / 207).the SVR rates in the adolescent and pediatric groups were 98.9% and99.1%,respectively.The SVR rates of 8W,12 W,and more than 12 W in the adolescent group were 99.3%,98.7%,and 97.1%,respectively;and the corresponding SVR rates in the children group were 98.2%,99.4%,and 99.1%,respectively.Headache,abdominal pain,diarrhea,and fatigue were the most common adverse events.No serious adverse events have been confirmed to be associated with DAAs.Conclusion: Direct-acting antiviral drugs are effective in the treatment of children and adolescents with chronic viral hepatitis C,and their efficacy is similar to that of adults;general adverse reactions are common,but severe adverse reactions are rare,and the drugs are generally safe.