Reply to HEP-17-1319.

We are disappointed that the Cochrane Group remains unconvinced that sustained virologic response (SVR) is a validated surrogate outcome and that direct-acting antiviral agents (DAAs) have been demonstrated to improve clinical as well as patient-reported outcomes in patients with chronic hepatitis C. Since our commentary in 2017, there have been many more studies supporting the benefits of SVR and DAA therapies, including a decline in patients added to the waiting list for liver transplantation for hepatitis C. We recognize that randomized controlled trials are the gold standards for showing the benefits of new treatments but given the robust evidence from clinical trials and observational studies all over the world, we do not believe that it is ethical to contemplate withholding clinically proven beneficial therapy. We stand by our associations' recommendations that all patients with chronic hepatitis C should be treated. This article is protected by copyright. All rights reserved.