Sunday, April 29, 2018

Cochrane Review Flawed For Discounting SVR As A Marker Of Viral Cure & Endpoint For Measuring Treatment Impact.

One Step Forward, Two Steps Back
Is it just me, or does it seem like each emerging milestone we make on the war against hepatitis C is eventually somewhat derailed? Either in the media, or worse yet, by failed and highly disputed research. Let me explain, over the years it went something like this; awareness (test all baby boomers, not everyone agreed), stigma (still working on it), cost (great drugs, too expensive), access & coverage (restrictions, you're not sick enough), and finally we cure the virus (Cochrane Review, cure, no proof of benefit).

Cochrane Review - Controversial Paper On HCV Therapy
Patients, advocates, and experts agree stigma and discrimination remains a barrier to testing and treatment, however, the benefit of curing hepatitis C with astounding cure rates is not all that controversial. Reason enough for experts to get caught up in a 2017 systematic review published by the Cochrane Collaboration on the benefit of achieving a cure using hepatitis C direct-acting antivirals (DAAs). The review concluded patients who were cured with DAA-based regimens did not reduce their risk for HCV-related morbidity or all-cause mortality. Within days, an outcry emerged from experts urging patients not to be influenced by the misleading and harmful conclusion, or be confused by any media coverage that followed.

*In case you missed the backstory, click here to review each expert rebuttal.

Cochrane Research Flawed 
Published April 10, 2018, online in Critical Public Health, patients can further explore the most recent rebuttal; Evidence-making controversies: the case of hepatitis C treatment and the promise of viral elimination.

*Thank you Henry E Chang, for downloading and sharing the full-text report on Twitter.

Here is an excerpt to get you started:
The EASL claims the Cochrane research has a ‘flawed methodological approach’, and that this is linked to its lack of hepatology expertise, including an ‘ignorance of the natural history of hepatitis C’. This ‘ignorance’ centres on the truth most troubled by the Cochrane review; that it ‘fails to accept that DAA treatment to attain an SVR is a pivotal outcome of treatment’, and that it ‘does not accept the likelihood that an SVR will reduce the risks of long-term outcomes of hepatitis C’. All the published responses we analysed (see above) present as ‘unanimous’ in characterising the Cochrane review as flawed for its discounting of SVR as a marker of viral cure and as an appropriate endpoint for measuring treatment impact.
Begin here.....

EASL's 2018 International Liver Congress - The Evidence Is In
Although this months "infohep bulletin" is not an official rebuttal over the failed Cochrane group's review, it does offer us an overview of EASL's 2018 International Liver Congress, and highlighted two studies at the meeting that "provided clear evidence that curing hepatitis C infection results in a reduction in the risk of dying from a liver-related cause."

Begin here....

Until next time,

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