Patients with hepatitis B virus infection treated with long-term nucleoside analogue therapy had a decreased risk for developing hepatitis B virus infection-related hepatocellular carcinoma, according to study data.
“Primary liver cancer is a dreaded complication of chronic hepatitis B (CHB) infection," Carla S. Coffin, MD, MSc, FRCPC, assistant professor of medicine, Liver Unit, University of Calgary, Canada, told healio.com/hepatology. "Our study is one of the largest North American cohort studies (and only in Canada) assessing the risk of HCC in patients with CHB on long-term potent nucleos/tide analog therapy.”
Carla S. Coffin
In a retrospective study, Coffin and colleagues analyzed data from 322 patients (median age, 46 years) with chronic HBV who underwent treatment with nucleoside analogues between 1999 and 2012 at the Calgary Liver Unit in Canada. The data, collected using the REACH-B model before the initiation of treatment, were used to predict annual risk for HCC. Patients were treated with either lamivudine, telbivudine (Tyzeka, Novartis), adefovir, entecavir or tenofovir (Viread, Gilead Sciences). Median follow-up was 3.2 years.
During follow-up, 11 patients developed HCC, most of whom had underlying cirrhosis and were negative for the hepatitis B e antigen. Seventeen percent of patients without HCC had cirrhosis (P<.00005). Of the 11 patients with HCC, five had been treated with lamivudine, three with tenofovir, two with adefovir and one with entecavir. Eighty-two percent of patients without HCC had been treated with either entecavir or tenofovir (P=.004).
Annual incidence of HCC was 0.9% per year (95% CI, 0.5-1.7) and the risk for HCC was highest in patients with cirrhosis compared with patients without cirrhosis (4.3% vs. 0.2%; P<.00005).
Univariate analysis showed older age (HR=1.07; 95% CI, 1.01-1.14) and cirrhosis (HR=21.8; 95% CI, 4.7-101.1) to be associated with developing HCC.
“By using a validated HCC risk prediction model for non-cirrhotic CHB patients, we found that patients on NA had a lower incidence of HCC development according to that predicted without treatment," Coffin said. "The study suggested that NA reduces the risk of CHB-related HCC. However, despite NA therapy and potent viral suppression, cirrhotic patients remain at risk.” by – Melinda Stevens
Disclosure: The study was supported by a grant from Gilead Sciences Canada. Some of the researchers report various financial ties with AbbVie, Astellas, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Idenix, Janssen, Merck, Novartis, Roche and Vertex.