Although patients with chronic hepatitis B developed hepatocellular carcinoma at a rate of 1.3 cases per 100 patient-years while receiving antiviral therapy, lamivudine resulted in significantly reduced incidence rates in a recent study.
Researchers evaluated data from studies assessing the impact of treatment for chronic HBV with orally administered antiviral agents on the risk for developing hepatocellular carcinoma (HCC). Studies included 20 or more patients followed up for longer than 2 years and were published between 1995 and 2013.
Among 49 studies, including 23 assessing lamivudine (LAM), 16, adefovir (ADV); and 10 of either entecavir (ETV), tenofovir (TDF) or telbivudine (TBV) in 10,025 patients, the pooled HCC incidence rate was 1.3 cases per 100 person-years. Significant heterogeneity was observed in this analysis (P<.0001); meta-regression indicated that patient age, study location and study type were the primary contributors to this heterogeneity.
Incidence rates were 1.3 cases per 100 patient-years for LAM, 1.5 for ADV and 1.3 for ETV, TDF or TBV. In studies where the mean age of patients was more than 50 years, patients had more than twice the pooled incidence rate than those with a mean age younger than 50 years. Patients with cirrhosis had an incidence rate approximately 10 times higher than that of noncirrhotics, and patients with detectable HBV DNA had nearly twice the HCC incidence rate as those with undetectable DNA.
Across six controlled studies assessing LAM in 3,306 patients during 43 months of follow-up, HCC risk was significantly reduced among recipients compared with 3,585 patients who received no therapy for a median follow-up of 43 months (OR=0.48; 95% CI, 0.38-0.61).
“Our meta-analysis demonstrates that LAM therapy is associated with a [more than 50%] reduction in the incidence of HCC among chronic HBV patients compared with no treatment,” the researchers concluded. “Although we did not observe a difference in the incidence of HCC based on the individual agent prescribed, additional prospective studies are needed that control for the confounders of subject age, gender, cirrhosis and HCC detection method to better estimate he risk of developing HCC among those receiving the newer antiviral agents.”
Disclosure: See the study for a full list of relevant disclosures.