Decreased risk of hepatocellular carcinoma recurrence with directacting antivirals compared with no treatment for hepatitis C: a meta-analysis

Abstract

Background Studies investigating the association between direct-acting antivirals (DAAs) and the recurrence of hepatocellular carcinoma (HCC) related to hepatitis C (HCV) have yielded conflicting results. The objective of this meta-analysis was to define the short-and long-term recurrence rates of HCC after DAA treatment.Methods A search of multiple databases was performed, including Scopus, Cochrane, MEDLINE/ PubMed and abstracts from gastroenterology meetings. Only studies reporting the recurrence of HCC in patients receiving DAA treatment, compared to HCV controls without DAA treatment, were evaluated. A meta-analysis was completed using the Mantel-Haenszel model. ResultsA comprehensive literature search resulted in 32 abstracts and papers. Six papers met our inclusion criteria and were included in the analysis. Follow up ranged from 1.25-4 years. Analysis of these 6 studies found a >60% lower risk of HCC recurrence in patients exposed to DAA compared to controls (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.27-0.47; P<0.001; I 2 =88%). A sensitivity analysis, which excluded studies showing the lowest recurrence rate to reduce heterogeneity, showed that patients receiving DAA still had a 60% lower risk of developing HCC (OR 0.4, 95%CI 0.26-0.61; P<0.0001; I 2 =39%) and a 66% lower risk of developing HCC beyond 1 year (OR 0.34, 95%CI 0.22-0.54; P<0.00001; I 2 =0%) compared to controls. ConclusionsThe use of DAA is associated with a significantly lower risk of HCC development compared to DAA-untreated patients, both overall and beyond 1 year of treatment. Further studies are needed to assess the impact of DAAs on early recurrence.

Tomoelastography for Longitudinal Monitoring of Viscoelasticity Changes in the Liver and in Renal Allografts after Direct-Acting Antiviral Treatment in 15 Kidney Transplant Recipients with Chronic HCV Infection

“…Notably, the non-responsiveness of this patient was not seen by HCV RNA load, ALT or serological fibrosis scores. The success of viral eradication in other studies has been reported, similarly to the present study, as being about 93% [ 10 , 13 , 56 ]. Thus, there is a need to identify those patients who will not respond to DAA therapy early, so that their therapy can be changed.…”

“…Furthermore, immunosuppression commonly applied to KTRs could also lead to a high risk of HCV reactivation and recurrence, resulting in the progression of hepatic fibrosis and, ultimately, a high incidence of liver cirrhosis and hepatocellular carcinoma [ 8 , 9 ]. Direct-acting antiviral agents (DAAs) are very effective in viral eradication, decreasing the risk of hepatocellular carcinoma [ 10 , 11 , 12 , 13 ]. As they are very effective in HCV therapy [ 14 , 15 , 16 , 17 ], DAAs are recommended by the current Kidney Disease Improving Global Outcomes (KIDGO) guidelines for treating HCV-infected patients with renal disease [ 18 ].…”

Impact of metformin use on the recurrence of hepatocellular carcinoma after initial liver resection in diabetic patients

“…We further stratified our study cohort based on the viral infection status. Multivariate analysis also revealed the treatment of HBV (HR, 0.601; 95% CI, 0.441–0.818; p = 0.001) and HCV (HR, 0.467; 95% CI, 0.328–0.664; p<0.001) are good independent factor for RFS in each group, the same results as previous study [ 32 – 34 ].…”

Hepatocellular carcinoma after direct-acting antiviral hepatitis C virus therapy: A debate near the end

“…After variable adjustments, the study reported that DAA exposure is not associated with an increased risk of HCC recurrence (HR = 0.90; 95%CI: 0.70-1.16)[ 60 ]. A meta-analysis published by Lui et al [ 61 ] also showed that the use of DAA therapy is associated with a significantly lower risk of HCC development compared to patients without DAA treatment. The authors found a > 60% lower risk of HCC recurrence in patients exposed to DAA compared to controls (OR = 0.36, 95%CI: 0.27-0.47; P < 0.001; I 2 = 88%).…”

“…In addition, a large comparative study from Japan revealed that posttreatment Wisteria floribunda agglutinin positive Mac-2 binding protein (WFA + M2BP) was significantly associated with HCC recurrence in patients with HCV without advanced liver fibrosis. In addition, the comparative study for occurrence and recurrence of HCC in IFN-based vs DAAs, showed that AFP (> 5.4 ng/mL) and WFA + M2BP levels (> 1.8 COI) were strongly associated with de novo HCC in those with DAA therapy[ 61 ]. In a recently published retrospective study, Sangiovanni et al [ 47 ] found at multivariable Cox regression models that ascites and AFP log-value were independently associated with HCC occurrence, while a history of alcohol abuse and HCC recurrence was associated with HCC recurrence.…”