Oral Direct-acting Antivirals and the Incidence or Recurrence of Hepatocellular Carcinoma: a Systematic Review and Meta-analysis

Overview

Journal Frontline Gastroenterol

Specialty Gastroenterology

Date 2018 Sep 25

PMID 30245788

Citations 14

Authors

Sonal Singh

Amit Nautiyal

Yoon K Loke

Affiliations

Soon will be listed here.

Abstract

Background: The influence of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus on the risk of hepatocellular carcinoma (HCC) is conflicting.

Methods: We conducted a systematic review and meta-analysis to determine the incidence or recurrence of HCC associated with oral DAA therapy. We searched PubMed, Scopus, Embase from inception to August 2017 to identify observational studies reporting on HCC among patients treated with DAAs. Two independent reviewers extracted data and assessed the risk of bias. Data were pooled by random-effects model. The primary outcome was the proportion of participants with incidence or recurrence of HCC (PROSPERO number CRD42017057040).

Results: After reviewing 2080 citations, we included 8 controlled studies and 36 uncontrolled studies. The pooled proportion for incident HCC was 1.5 % (95% CI 1.0% to 2.1%; I=90.1%; n= 542/39 145) from 18 uncontrolled studies and 3.3% (95% CI 1.2% to 9%; I =96%; n=109/6909) from 5 controlled studies, respectively. The pooled proportion for recurrent HCC was 16.7% (95% CI 10.2% to 26%; I=84.8%; n=136/867) from 12 uncontrolled studies and 20.1% (95% CI 5.5% to 52.1%; I=87.5%; n=36/225) from 3 controlled studies, respectively. There was no statistically significant effect on the risk of recurrent HCC (OR 0.50, 95%CI 0.16 to 1.59; I =73.4%) in a meta-analysis of three studies.

Conclusions: Our findings show low proportion of incident HCC, but high proportion of recurrent HCC on treatment with DAAs. Continued active surveillance for HCC after treatment with DAAs remains prudent.

Citing Articles

Impact of viral eradication by direct-acting antivirals on clinical outcomes after curative treatment for hepatitis C virus-associated hepatocellular carcinoma.

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Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection.

Ibrahim Salama I, Raslan H, Abdel-Latif G, Salama S, Sami S, Shaaban F World J Hepatol. 2022; 14(6):1053-1073.

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Atif M, Mustaan M, Falak S, Ghaffar A, Munir B Saudi J Biol Sci. 2022; 29(8):103332.

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Multimodal Treatment of Hepatocellular Carcinoma in Patients With Hepatitis C Virus Infection Treated With Direct-Acting Antivirals.

Mercan-Stanciu A, Isac T, Rababoc R, Rusie D, Toma L, Vacaroiu I Cureus. 2022; 14(5):e25487.

PMID: 35800821 PMC: 9246468. DOI: 10.7759/cureus.25487.

Antiviral Therapy Improves Hepatocellular Cancer Survival.

Nguyen N, Patel K, Uhelski A, Waters B, Weir A Fed Pract. 2021; 38(Suppl 3):e58-e63.

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