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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Bertrand HANSLIK
Coup de coeur :
 
 
Gut
  2018/11  
 
  2018 Nov;67(11):2025-2034  
  doi: 10.1136/gutjnl-2018-316234.  
 
  Impact of sustained virological response on the extrahepatic manifestations of chronic hepatitis C: a meta-analysis.  
 
  Cacoub P, Desbois AC, Comarmond C, Saadoun D  
  https://www.ncbi.nlm.nih.gov/pubmed/29703790  
 
 

Abstract

BACKGROUND AND AIMS:

Extrahepatic manifestations of HCV are responsible for morbidity and mortality in many chronically infected patients. New, interferon-free antiviral treatment regimens, which present the opportunity to treat all HCV-infected patients, call for a better understanding of the benefits of treating non-cirrhotic chronically infected individuals.

METHODS:

A systematic review was conducted. Identified studies from targeted database searches on Embase and Medline were screened. The methodological quality of the included publications was evaluated. Random-effect model meta-analyses were performed. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system.

RESULTS:

Data were extracted from a total of 48 identified studies. Achieving sustained virological response (SVR) was associated with reduced extrahepatic mortality (vs no SVR, OR 0.44 (95% CI 0.28 to 0.67)). SVR was associated with higher complete remissions in patients with cryoglobulinemia vasculitis (OR 20.76 (6.73 to 64.05)) and a higher objective response in those with malignant B-cell lymphoproliferative diseases (OR 6.49 (2.02 to 20.85)). Achieving SVR was also associated with reduced insulin resistance at follow-up (OR 0.42 (0.33 to 0.53)) and a significant protective effect on the incidence of diabetes (OR 0.34 (0.21 to 0.56)). Lack of randomised data comparing SVR versus non-SVR patients for the relevant extrahepatic indications attenuated these analyses.

CONCLUSION:

Antiviral therapy can reduce extrahepatic manifestations related to HCV when SVR is achieved. Higher quality data, and reporting over longer follow-up periods, will be required to thoroughly explore comprehensive HCV treatment strategies.

 

 
Question posée
 
Confirmer l’impact d’une RVS sur la morbi-mortalité extra-hépatique chez les patients avec hépatite chronique virale C.
 
Question posée
 
Une métaanalyse, avec ses limites, liées notamment à la relative rareté de ces manifestations extrahépatiques dans les études, et à la très grande efficacité des AVD, qui vient confirmer l’intérêt de traiter tous les patients porteurs du VHC.
 
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