Results of a recent study provided continued confirmation that increased rates of hepatocellular carcinoma among patients treated with direct-acting antivirals compared with interferon correlated with patient characteristics such as age and liver function rather than treatment.
“Despite a lack of long term follow-up, there have recently been several alarming reports suggesting ‘unexpectedly high’ rates of HCC incidence under and following DAA regimens in cirrhotic patients,” Pierre Nahon, MD, from the Hospital Jean Verdier in France, and colleagues wrote. “However, this twofold increase in risk is modest, limited in time and can at least partially be explained by confounders linked to the specific profile of patients bearing higher risk factors for the development of liver cancer.”
Nahon and colleagues analyzed treatment outcomes of 1,270 patients including a DAA group (n = 336), a group of patients who achieved sustained virologic response after interferon therapy (n = 495), and a group of patients who did not achieve SVR regardless of treatment (n = 439).
During a mean follow-up of 67.5 months, the researchers observed a first hepatic focal lesion in 441 patients with a 5-year cumulative incidence of 33.9%. More than half of the hepatic focal lesions remained indeterminate or were benign.
Patients who received DAA therapy had shorter follow-up (21.2 months) compared with patients with SVR from interferon (64.4 months) and non-SVR patients (47.4 months; P < .001).
Three-year crude HCC incidence was lower in patients who received DAA therapy compared with non-SVR patients (5.9% vs. 12.7%; P = .014), but higher when compared with patients who achieved SVR with interferon therapy (5.9% vs. 3.1%; P = .03).
Compared with the interferon group, DAA patients were significantly less likely to have had an HCC screening interval of less than 7 months prior to treatment initiation (75.3% vs. 96.6%; P < .0001).
Based on multivariate analysis, factors associated with the development of liver cancer included age, past excessive alcohol consumption, hepatitis C genotype 1, decreased platelet count and increase gamma-glutamyl transferase levels, whereas the researchers found no significant correlation between DAA therapy and HCC risk.
“A more detailed analysis according to treatment allocation and SVR status confirmed that patients who achieved SVR following DAAs therapy did not have a significantly higher risk of developing HCC as compared with those who achieved SVR following interferon-based regimen,” the researchers wrote. – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.