Interferon treatment in Hemodialysis patients with chronic hepatitis C virus infection: A systematic review of the literature and meta-analysis of treatment efficacy and harms

Background: Hepatitis C virus (HCV) infection is prevalent in patients undergoing hemodialysis and is associated with greater mortality. We determined the efficacy and harms of interferon (IFN) and pegylated IFN (PEG-IFN) treatment of hemodialysis patients with chronic HCV infection and identified factors associated with these outcomes. Study Design: Meta-analysis and meta-regression of randomized controlled trials, uncontrolled trials, and prospective observational studies. Setting & Population: Hemodialysis patients with chronic HCV infection. Selection Criteria for Studies: MEDLINE indexed studies since 1966, sample size greater than 10. Intervention: IFN-based treatment, including PEG-IFN with and without ribavirin. Outcomes: Sustained virological response (SVR) 6 months after treatment, rate of treatment discontinuation caused by adverse events, and factors associated with these outcomes. Results: 20 studies of 459 IFN-treated patients, 3 studies of 38 PEG-IFN-treated patients, and 2 studies of 49 PEG-IFN and ribavirin-treated patients met inclusion criteria. The overall SVR rate was 41% (95% confidence interval [CI], 33 to 49) for IFN and 37% (95% CI, 9 to 77) for PEG-IFN. Treatment discontinuation rates were 26% (95% CI, 20 to 34) for IFN and 28% (95% CI, 12 to 53) for PEG-IFN. SVR was higher with 3 million units (MU) or higher of IFN 3 times weekly, with lower mean HCV RNA, and with lower rates of cirrhosis, HCV genotype 1 or elevated transaminase, but these findings were not statistically significant. Treatment discontinuation rates were greater in studies using larger doses. Limitations: Publication bias, few randomized controlled trials, and limitations in generalizability to all hemodialysis patients. Conclusion: IFN treatment of hemodialysis patients results in an SVR rate of 41 %. Higher dose, lower mean HCV RNA level, and lower rates of cirrhosis, transaminase level increase, and HCV genotype 1 may be associated with greater SVR rates, but additional studies using individual patient data are needed. Am J Kidney Dis 51:263-277. (c) 2008 by the National Kidney Foundation, Inc.