Background: The treatment for hepatitis C virus (HCV) infection has evolved over time, and direct-acting antivirals (DAA) have revolutionized HCV therapy. However, real-world data on treatment discontinuation of DAA are scarce.
Objectives: To qualitatively synthesize the available real-world evidence regarding the treatment discontinuation of DAA therapies among patients with HCV.
Methods: A comprehensive systematic search was performed using electronic scientific databases (PubMed and Scopus) from their inception through 6th, December 2022, where studies related to treatment discontinuation of DAA were identified. Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields tool was used to assess the quality of each included study.
Results: Of 252 initial search results (113- PubMed and 139- Scopus), 15 studies were finally included for qualitative synthesis after titles, abstracts and full-text screening. The majority of the included studies were prospective observational cohort studies (11) while the remaining were retrospective studies (4) from across the globe (USA- 4; Italy- 3; Australia- 2; Germany- 2; Japan- 1; Spain-1; Canada-1 and Brazil-1). There was a cumulative total of 36,006 patients (predominantly males- 63.1%) with a mean age of 54.7 years. Genotype-1 (12), -2 (8), -3 (8) and -4 (5) are the most common types of genotypes, where all the studies had a treatment duration of 12 weeks. The overall average SVR (12 or 24) rate was achieved by 85.4%, while treatment discontinuation of DAA was found to be 3.8%. Anaemia, headache, fatigue, rash, insomnia, nausea, vomiting, pruritus, jaundice, hepatic decompensation, dyspepsia, hypersensitivity, depression and abdominal pain were the most common adverse events reported.
Conclusions: Real-world discontinuation of DAA therapy was found to be low, where adverse events, older age and advanced liver disease were linked to DAA treatment interruption. Identification of risk factors associated with treatment discontinuation is important to recognize patients who should be followed up closely during the treatment.
