By Kristina Fiore, Staff Writer, MedPage Today
Published: October 26, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
Treatment with antivirals may prevent liver cancer in patients with fibrosis or cirrhosis related to hepatitis C (HCV), researchers found.
Action Points
The effect is even more pronounced among patients with a better response to therapy, they noted.
To determine the effect of antiviral therapy on the risk of developing hepatocellular carcinoma in patients with chronic hepatitis C, Kimer and colleagues conducted a review and meta-analysis of eight randomized controlled trials that compared interferon or pegylated interferon, alone or in combination with ribavirin, with placebo or no intervention.
They also looked at five prospective cohort studies in sensitivity analyses.
In the randomized trials, the duration of therapy ranged from 1 to 5 years, and the duration of follow-up was between 2 to almost 9 years.
The researchers found that antiviral therapy cut the risk of hepatocellular carcinoma by almost half (RR 0.53, 95% CI 0.34 to 0.81).
That translated to a number needed to treat of eight patients.
In subgroup analyses, antiviral therapy was more beneficial in virological responders than in non-responders, Kimer and colleagues added (P=0.03).
But they noted that there was "a clear effect in both patient groups."
In addition, they found no evidence of bias in regression analyses.
Sensitivity analyses involving the five additional cohort studies also showed that antiviral therapy reduced the risk of hepatocellular carcinoma (RR 0.29, 95% CI 0.12 to 0.69).
They cautioned, however, that there was "clear evidence of bias" in these studies (P=0.02).
Additionally, in the four randomized trials that assessed mortality outcomes, there was no difference between treated and untreated groups in terms of all-cause or liver-related death.
There were a number of caveats in this study. For instance, only two trials used pegylated interferon, which is the current standard treatment instead of regular interferon. And most of the trials looked at interferon monotherapy, while the standard of care currently involves the addition of ribavirin.
Triple therapy with newer agents -- the protease inhibitors telaprevir (Incivek) and boceprevir (Victrelis) -- is also becoming part of routine care, although some clinicians are even holding out for all-oral regimens currently in development.
Thus, the researchers concluded, "direct extrapolation of the observed effects to clinical practice is difficult. The protection from hepatocellular carcinoma might be even better among patients in current antiviral therapy since the proportion of virological responders continues to increase with ongoing improvements in therapy."
Primary source: BMJ
Source reference:
Kimer N, et al "Antiviral therapy for prevention of hepatocellular carcinoma in chronic hepatitis C: systematic review and meta-analysis of randomized controlled trials" BMJ 2012; DOI: 10.1136/bmjopen-2012-001313.
Related
Oct 25- Less Liver Cancer in HCV Patients Given Antiviral Therapy
Oct 23- New Meta-Analysis Study: Antiviral therapy for prevention of hepatocellular carcinoma in chronic hepatitis C: systematic review and meta-analysis of randomised controlled trials: HCC incidence is diminished in both virological responders and non-responders -- see new study below these links to other recent studies also showing SVR reduces cancer, mortality
Oct 22- Hepatitis C - Antiviral drugs cut liver cancer risk
Action Points
- Treatment with antivirals may prevent liver cancer in patients with fibrosis or cirrhosis related to hepatitis C.
- Note that in the four randomized trials that assessed mortality outcomes, there was no difference between treated and untreated groups in terms of all-cause or liver-related death
The effect is even more pronounced among patients with a better response to therapy, they noted.
To determine the effect of antiviral therapy on the risk of developing hepatocellular carcinoma in patients with chronic hepatitis C, Kimer and colleagues conducted a review and meta-analysis of eight randomized controlled trials that compared interferon or pegylated interferon, alone or in combination with ribavirin, with placebo or no intervention.
They also looked at five prospective cohort studies in sensitivity analyses.
In the randomized trials, the duration of therapy ranged from 1 to 5 years, and the duration of follow-up was between 2 to almost 9 years.
The researchers found that antiviral therapy cut the risk of hepatocellular carcinoma by almost half (RR 0.53, 95% CI 0.34 to 0.81).
That translated to a number needed to treat of eight patients.
In subgroup analyses, antiviral therapy was more beneficial in virological responders than in non-responders, Kimer and colleagues added (P=0.03).
But they noted that there was "a clear effect in both patient groups."
In addition, they found no evidence of bias in regression analyses.
Sensitivity analyses involving the five additional cohort studies also showed that antiviral therapy reduced the risk of hepatocellular carcinoma (RR 0.29, 95% CI 0.12 to 0.69).
They cautioned, however, that there was "clear evidence of bias" in these studies (P=0.02).
Additionally, in the four randomized trials that assessed mortality outcomes, there was no difference between treated and untreated groups in terms of all-cause or liver-related death.
There were a number of caveats in this study. For instance, only two trials used pegylated interferon, which is the current standard treatment instead of regular interferon. And most of the trials looked at interferon monotherapy, while the standard of care currently involves the addition of ribavirin.
Triple therapy with newer agents -- the protease inhibitors telaprevir (Incivek) and boceprevir (Victrelis) -- is also becoming part of routine care, although some clinicians are even holding out for all-oral regimens currently in development.
Thus, the researchers concluded, "direct extrapolation of the observed effects to clinical practice is difficult. The protection from hepatocellular carcinoma might be even better among patients in current antiviral therapy since the proportion of virological responders continues to increase with ongoing improvements in therapy."
The researchers reported no conflicts of interest.
Primary source: BMJ
Source reference:
Kimer N, et al "Antiviral therapy for prevention of hepatocellular carcinoma in chronic hepatitis C: systematic review and meta-analysis of randomized controlled trials" BMJ 2012; DOI: 10.1136/bmjopen-2012-001313.
Related
Oct 25- Less Liver Cancer in HCV Patients Given Antiviral Therapy
Oct 23- New Meta-Analysis Study: Antiviral therapy for prevention of hepatocellular carcinoma in chronic hepatitis C: systematic review and meta-analysis of randomised controlled trials: HCC incidence is diminished in both virological responders and non-responders -- see new study below these links to other recent studies also showing SVR reduces cancer, mortality
Oct 22- Hepatitis C - Antiviral drugs cut liver cancer risk
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