No increased HCC risk after HCV SVR seen with DAAs vs. interferon
AMSTERDAM — When adjusted for age and severity of liver disease, occurrence and recurrence of hepatocellular carcinoma after curing hepatitis C virus showed no difference between treatment with interferon or direct-acting antivirals, according to an expert at the International Liver Congress.
“Our meta-analysis has found that there is no evidence for differential HCC occurrence or recurrence following a cure from DAA or interferon-based regimens. Higher incidence after DAA therapy can be explained by a shorter duration or the so-called ‘cohort effect’ and older age of those at baseline as a higher baseline risk,” Gregory Dore, MD, of the Kirby Institute in Sydney, Australia, said during a press conference.
The question Dore and colleagues proposed was whether interferon offered an additional protective effect against HCC that DAAs lack. They aimed to answer this through a systematic review and meta-analysis of 26 studies looking at the occurrence of HCC after SVR and 15 studies looking at the recurrence.
At baseline in the HCC occurrence studies, Dore showed that the mean age in the DAA treatment group was 8 years older than that of the interferon group.
“Age is an important factor even in people with cirrhosis,” Dore said.
Additionally, in the occurrence groups, 100% of patients treated with interferon had compensated cirrhosis while 34% of those treated with DAAs had Child Pugh B or C cirrhosis.
“To put it in context, the treatment has completely changed. We are not addressing the same population. This is critical,” Laurent Castera, MD, PhD, EASL Secretary General, said at the press conference.
Both the occurrence and recurrence analysis showed that follow-up for DAAs remains around 1 year while follow-up for interferon trended toward 5 years.
Before adjustment, Dore showed that analysis appeared to represent a threefold increase in HCC occurrence with DAAs (1.14 per 100 person-years vs. 3.09 per 100 person-years).
“When you adjust these risks, it completely changes,” he said.
Adjusting for age and follow-up, HCC occurrence was similar between the interferon-treated and DAA-treated groups (9.21 per 100 person-years vs. 12.14 per 100 person-years).
In the meta-regression adjusted analysis, Dore showed that DAA therapy was not associated with a higher occurrence of HCC (RR = 0.7; 95% CI, 0.2-2.6) or recurrence of HCC (RR = 1.4; 95% CI, 0.5-4.1).
Dore explained that the shorter duration of DAA therapy and, subsequently, follow-up adds to the appearance of higher HCC incidence. With longer treatment periods when using interferon, incidences seen while on-treatment would not be considered in a post-SVR analysis.
In the recurrence analysis, Dore explained, the groups were much more similar because “Recurrence is not that unusual,” he said.
In summary, Dore said, “The best HCC prevention strategy and the best way to reduce HCC mortality is to scale up HCV therapy as broadly and rapidly as you can and there is absolutely no doubt that will have an impact on HCC burden.” – by Katrina Altersitz
Waziry R. PS160. Presented at: International Liver Congress; April 19-24, 2017; Amsterdam.
Disclosures: Dore reports no relevant financial relationships.