WASHINGTON — Reaching sustained virologic response with direct-acting antivirals reduced the occurrence of hepatocellular carcinoma by 71%, but all treatments that cleared the virus saw a similar reduction in risk, according to a presenter at The Liver Meeting 2017.
“Our results show that DAA-induced SVR is associated with a 71% reduction in HCC,” George N. Ioannou, MD, from the Veterans Affairs Puget Sound Healthcare System and the University of Washington, said in his presentation. “Eradication of HCV is associated with a similar reduction in HCC irrespective of the regimen that is used to achieve that eradication.”
Ioannou presented data from the Veterans Affairs health care system, conducting a retrospective cohort study on patients who started antiviral therapies from 1999 through 2015 (n = 62,354). Of these, 58% (n = 35,871) received interferon only; 7% (n = 4,535) received interferon plus a DAA; and 35% (n = 21,948) received only DAAs.
“We used data from the national VA health care system,” he said. “It’s the largest integrated health care system in the United States and also contains the largest number of patients with hepatitis C infection and the largest number of patients with hepatocellular carcinoma and cirrhosis.”
The researchers followed these patients through June 15, 2017, with follow-up ranging from 2 to 18 years (mean follow-up = 6.1 years) and found 3,271incident cases of HCC.
Ioannou defined incident HCC as an HCC diagnosis at least 180 days after initiation of HCV treatment. He said they did not include any within those 180 days because “these cancers most likely were present at the beginning of antiviral treatment and were clinically occult and there was no way the antiviral treatment could have influenced their incidence one way or the other.”
He showed that the incidence of HCC was highest in patients with cirrhosis who also failed treatment (3.25 per 100 patient-years)
Ioannou said their study “clearly shows that patients with SVR had a lower incidence of hepatocellular carcinoma, both among cirrhotic patients ... and among non-cirrhotic patients.”
Additionally, he said this difference is only more obvious as follow-up continues.
“The difference between the SVR and the no-SVR group, if anything, keeps increasing over time. The more years that accrue, the greater the difference in incidence of hepatocellular carcinoma between the SVR and the no-SVR group, both in the cirrhotic and the non-cirrhotic patients,” he said.
After adjusting for 21 confounding factors, Ioannou said that obvious difference still stood. Looking at all patients, they linked SVR to a 61% reduction in HCC risk (adjusted HR = 0.39; 95% CI, 0.35-0.43). It was similarly reduced in both patients with cirrhosis (aHR = 0.50; 95% CI, 0.43-0.59) and those without (aHR = 0.32; 95% CI, 0.28-0.37).
“Eradication of hepatitis C is associated with a similar reduction of HCC in both cirrhotic and non-cirrhotic patients,” he said.
Lastly, Ioannou showed that the reduction was also similar between the treatment regimens: interferon-only (aHR = 0.32; 95% CI, 0.28-0.37), DAA with or without interferon (aHR = 0.48; 95% CI, 0.32-0.73) or DAA-only (aHR = 0.29; 95% CI, 0.23-0.37).
In a secondary analysis, Ioannou and colleagues looked specifically at whether DAAs somehow increased risk for HCC post-SVR. They did so by limiting their cohort to 2009 to 2015 and just 2 years of follow-up.
“Finally, we see that DAAs are not associated with an increased risk of HCC compared to receiving interferon,” he concluded. – by Katrina Altersitz
Ioannou GN, et al. Abstract 142. Presented at: The Liver Meeting; Oct. 20-24, 2017; Washington, D.C.
Disclosure: Ioannou reports receiving grant or research support from Janssen Pharmaceuticals.
Editor's note: This item has been updated to include more accurate data.