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Conclusion
To conclude, we are aware that definite proof for the surrogacy of SVR and clinical benefit of interferon-based antiviral therapy is lacking.
Nevertheless, SVR has been repeatedly associated with improvements in health-related quality of life, hepatic inflammation and fibrosis, and portal pressure as well as with a reduced occurrence of solid clinical endpoints such as hepatocellular carcinoma, liver failure and death.
Collectively, this strongly argues that SVR is a patient-relevant endpoint and reasonably likely to predict clinical benefit [13].
Furthermore, there is no clear evidence to suggest a long-term harmful effect of 24–48 weeks of interferon-based therapy, by which we usually attempt to achieve this virological outcome measure in our patients. With future triple therapy, a treatment duration of 12 weeks might even be sufficient [79].
The increased mortality rate in a subgroup of patients who received long-term interferon maintenance therapy is not representative for short-term antiviral therapy with the potential to result in SVR.
Nevertheless, we do acknowledge that interferon-based therapy is accompanied by substantial side-effects, which was also highlighted again by the recent meta-analysis [6].
Thus, careful patient selection remains a necessity at this time, and better tolerated interferon-free treatment regimens with combinations of direct-acting antiviral agents are urgently required.
We oppose, however, that the results of the recent Cochrane meta-analysis, or more specifically the HALT-C study, should discourage physicians from treating their patients with chronic HCV infection in general.
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Journal of Hepatology
Volume 60, Issue 1, Pages 191–196, January 2014
Is there sufficient evidence to recommend antiviral therapy in hepatitis C?
Adriaan J. van der Meeremail, Heiner Wedemeyer, Jordan J. Feld, Bettina E. Hansen, Michael P. Manns, S. Zeuzem, Harry L.A. Janssen