Pioglitazone as adjunctive treatment for patients with chronic Hepatitis C receiving PEG interferon and Ribavarin

Background: Chronic hepatitis C is widely known to be associated with insulin resistance, type 2 diabetes, and metabolic syndrome. Insulin resistance predicts faster progression to fibrosis and cirrhosis that may culminate in liver failure and hepatocellular carcinoma. It also predicts poor response to anti-retroviral therapy. Insulin sensitizers such as Pioglitazone may help improve the effects of anti-retroviral therapy among hepatitis C patients. This meta-analysis aims to determine the effects of Pioglitazone in sustaining virologic response among chronic hepatitis C patients.

Methods: Relevant articles were systematically retrieved from PubMED, Cochrane Library Central register of Controlled trials and OVID. The outcomes analyzed were sustained Viral Response (SVR) and End of treatment Viral Response (EVR). Association of SVR and EVR with the addition of Pioglitazone was analyzed using odds ratio.

Results: A total of 16 studies were screened and 4 studies were included in the qualitative synthesis, while 3 studies were included in the quantitative analysis. Systemic Viral Response was not significant between patients receiving Pioglitazone in addition to standard anti-retroviral therapy compared to those who received standard treatment alone (OR 0.58; 95% CI 0.30 to 1.12). End of treatment viral response favored the addition of Pioglitazone (OR 0.36; 95% CI 0.18 to 0.73) compared to standard treatment alone.

Conclusion: The addition of Pioglitazone as an adjuvant to the standard therapy of chronic Hepatitis C showed favorable response but was not statistically significant. Further studies with larger sample size may be needed to provide a more conclusive result.