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EASL Response to the Cochrane Systematic Review on DAA-Based Treatment of Chronic Hepatitis C

EASL, the European Association for the Study of the Liver, one of the leading associations of liver specialists, expresses serious concerns after the recent publication of a Cochrane Group systematic review entitled “Direct acting antivirals for chronic hepatitis C” by Jakobsen et al. After reviewing 138 clinical trials, including 25,232 participants, the authors conclude that: “Overall, direct acting antivirals (DAAs) on the market or under development do not seem to have any effects on risk of serious adverse events. […] we could neither confirm nor reject that DAAs had any clinical effects. DAAs seemed to reduce the risk of no sustained virological response. The clinical relevance of the effects of DAAs on no sustained virological response is questionable, as it is a non-validated surrogate outcome. All trials and outcome results were at high risk of bias, so our results presumably overestimate benefit and underestimate harm. The quality of the evidence was very low.”

The inability of the authors of the Cochrane review to determine a clinical benefit of DAA-based treatment of hepatitis C reflects an inaccurate methodological approach and does not take into account the natural history of hepatitis C virus (HCV) infection and associated systemic diseases. Download the document.