Outcomes of Interferon-free Direct Acting Antivirals in Patients with HCV-related Decompensated Cirrhosis: A Systematic Review and Meta-analysis

Abstract

Abstract Direct-acting antiviral (DAA) is an effective treatment for chronic hepatitis C. However, the treatment benefit on overall and hepatocellular carcinoma-free survival remains unanswered. This meta-analysis aimed to assess overall survival (OS), HCC-free survival and the Model for End-stage Liver Disease score (MELD) improvement. Relevant studies were identified by searching MEDLINE, SCOPUS and CENTRAL. OS and HCC-free survival probabilities and time data were extracted from Kaplan-Meier curves. A one-stage meta-analysis using parametric Weibull regression was applied to estimate relative treatment effects of DAA versus no-DAA. Eight cohorts with 3430 participants (2603 cases in DAA and 1999 cases in no-DAA groups) were included. The OS probabilities at 12- and 24-months were 95% and 90% for the DAA group, comparing with 89% and 80% in the no-DAA group. The hazard ratios (HR) was 0.48 (95% CI: 0.39, 0.60; p<0.001). The HCC-free survival probabilities at 12- and 24-months were 96% and 90% in the former and 94% and 85% in the later. The HR was 0.72 (95% CI: 0.52, 1.00; p = <0.001). The mean MELD score difference was -7.75 (95% CI: -14.52, -0.98; p = 0.02). DAA treatment in decompensated HCV cirrhosis patients prolongs OS, improves MELD score and may reduce HCC occurrence. Trial Registration: PROSPERO (ID:CRD42022316276).