Aspirin Reduces the Incidence of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Receiving Oral Nucleos(t)ide Analog

Hui, Vicki Wing‐Ki; Yip, Terry Cheuk‐Fung; Wong, Vincent Wai‐Sun; Tse, Yee‐Kit; Chan, Henry Lik‐Yuen; Lui, Grace Chung‐Yan; Wong, Grace Lai–Hung

doi:10.14309/ctg.0000000000000324

Cited by 21 publications

(36 citation statements)

References 28 publications

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“…Nine studies (n = 115 124) reported on HCC incidence. [28][29][30][31][32][33][34][35][36] The pooled aHR from seven matched cohort and case-control studies…”

Section: Hcc Incidencementioning

confidence: 99%

“…(n = 51 799) [28][29][30][31][32]35,36 which evaluated aspirin use compared to no aspirin use showed moderate evidence that aspirin is associated with a significantly reduced risk of HCC incidence; HR: 0.51, 95% CI: 0.36-0.72 (Figure 2A). The quality of evidence was downgraded one level for inconsistency.…”

Section: Hcc Incidencementioning

confidence: 99%

“…Six studies [28][29][30]36,38,46 provided proportion data for the gastrointestinal bleeding complications for the drug intervention used (Figure 2D). One RCT study of COX-2-selective inhibitors 44 (n = 71)…”

Section: Bleeding Complicationsmentioning

confidence: 99%

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Systematic review with meta‐analysis: The effects of non‐steroidal anti‐inflammatory drugs and anti‐platelet therapy on the incidence and recurrence of hepatocellular carcinoma

Tan

Lockart

Shaheed

et al. 2021

Aliment Pharmacol Ther

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Background: Chemoprevention with NSAIDs, including aspirin, and anti-platelet therapy (APT), has been suggested to reduce the incidence and recurrence of hepatocellular carcinoma (HCC).Aim: To determine by meta-analysis whether NSAIDs and APT use affected HCC incidence, HCC recurrence and liver-related mortality in at-risk populations with chronic liver disease.Method: Electronic databases including Pubmed, Scopus, Medline, Embase and Cochrane Library were searched (from inception to 31 May 2021) for eligible studies evaluating the impacts of NSAID or APT use on HCC incidence, recurrence and mortality. Data on HCC incidence, recurrence, liver-related mortality or bleeding complications had to be available. Studies were included if they evaluated adults with hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol-related liver disease (ALD) or nonalcoholic steatohepatitis that were administered at least one NSAID or APT for a defined period of time and were followed for at least 6 months. The primary outcome was HCC incidence. Secondary outcomes included: HCC recurrence, liver-related mortality and bleeding complications. Data were pooled using a random effects model with hazard ratios (HRs) or odds ratio (OR), and 95% confidence intervals (CIs) presented.Results: Of 3773 articles screened, 19 studies were included, with a total of 147 283 participants. Aspirin use reduced the risk of HCC incidence (HR: 0.51, 95% CI: 0.36-0.72); and improved liver-related mortality (OR: 0.32, 95% CI: 0.15-0.70), with a small increased risk of gastrointestinal bleeding events (OR: 1.32, 95% CI: 1.08-1.94). With respect to HCC recurrence following treatment, analysis of all aspirin and NSAID treatment (including; aspirin only; non-aspirin NSAIDs only; and combination NSAIDs groups) was associated with a decreased risk of HCC recurrence (HR: 0.80, 95% CI: 0.75-0.86). By stratified analysis, only the non-aspirin NSAID group showed significant risk reduction (HR: 0.73, 95% CI: 0.63-0.84). Conclusion:The study supports the use of aspirin in at-risk individuals to reduce the incidence of HCC and liver-related mortality. HCC recurrence following treatment was lower with NSAID treatment. | 357 TAN eT Al.

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“…Nine studies (n = 115 124) reported on HCC incidence. [28][29][30][31][32][33][34][35][36] The pooled aHR from seven matched cohort and case-control studies…”

Section: Hcc Incidencementioning

confidence: 99%

Section: Hcc Incidencementioning

confidence: 99%

See 1 more Smart Citation

Systematic review with meta‐analysis: The effects of non‐steroidal anti‐inflammatory drugs and anti‐platelet therapy on the incidence and recurrence of hepatocellular carcinoma

Tan

Lockart

Shaheed

et al. 2021

Aliment Pharmacol Ther

View full text Add to dashboard Cite

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“…70 The most recent cohort study of 35,111 Hong Kong HBV patients receiving NA treatment reported consistent findings as well as dose-response relationship (HR: 0.65, 0.63 and 0.41 for 0.25-2, 2-5 and ≥ 5 years, respectively). 71 According to a cohort study based on Taiwan's National Health Insurance database, aspirin lowered HCC risk in HCV patients by about 50%. 72 A subsequent Taiwanese cohort study with a higher proportion of HCV-related cirrhotic patients reported consistent findings (HR = 0.78, 95% CI:0.64-0.95) but no statistical significance was observed in cirrhotic subgroup (HR = 0.75, 95% CI: 0.55-1.03).…”

Section: %) 68mentioning

confidence: 99%

Statin and aspirin for chemoprevention of hepatocellular carcinoma: Time to use or wait further?

Goh

Sinn

2022

Clin Mol Hepatol

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Preclinical studies highlighted potential therapeutic applications of aspirin and statins as anticancer agents based on their pleotropic effects. Epidemiologic studies suggested the role of aspirin and statins in the chemoprevention of hepatocellular carcinoma (HCC). However, observational data is prone to bias, and no prospective randomized trials are currently available to assess the risks and benefits of statin or aspirin therapy for chemoprevention of HCC. It is therefore important for clinicians and researchers to be aware of the quality of current evidence regarding this issue. In this review, we summarize currently available evidence to assist clinicians with their decision to use statin or aspirin and provide information for further clinical investigations.

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“…Liver fibrosis refers to the pathological process of abnormal hyperplasia of connective tissue in the liver, which is an important factor affecting the prognosis of chronic liver disease. Clinical trials have found that patients with hepatitis B cirrhosis may show liver fibrosis and increased expression levels of serum inflammatory factors during treatment, leaving them in a microinflammatory state for a long time and thus affecting the therapeutic effect [ 5 ]. Entecavir, adefovir dipivoxil, and lamivudine, with antibacterial and antivirus effects, are common and effective clinical drugs to treat liver cirrhosis [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Entecavir Combined with Adefovir Dipivoxil on Clinical Efficacy and TNF-α and IL-6 Levels in Patients with Hepatitis B Cirrhosis

Cui

Zhao

et al. 2021

Journal of Oncology

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Objective. The purpose of the study was to investigate the effect of entecavir combined with adefovir dipivoxil on clinical efficacy and TNF-α and IL-6 levels in patients with hepatitis B cirrhosis. Methods. A total of 100 patients with hepatitis B cirrhosis admitted to our hospital between January 2018 and June 2019 were randomly selected and divided into the control group (n = 50) and experimental group (n = 50) according to the order of admission. Among them, the control group patients were treated with entecavir, while the patients in the experimental group received entecavir combined with adefovir dipivoxil. After that, the effective rate of treatment, the incidence of adverse reactions, liver function indexes, liver fibrosis condition, and TNF-α and IL-6 expression levels were all compared between the two groups. Results. The effective rate of treatment in the experimental group was significantly higher than that in the control group, with statistical significance ( p < 0.001 ); the incidence of adverse reactions of the patients in the experimental group was significantly lower than that in the control group, with statistical significance ( p < 0.001 ); the liver function indexes in the experimental group were significantly better than those in the control group, with statistical significance ( p < 0.001 ); the number of patients with liver fibrosis in the experimental group was significantly less than that in the control group, with statistical significance ( p < 0.001 ); the TNF-α and IL-6 expression levels in the experimental group were significantly lower than those in the control group, with statistical significance ( p < 0.001 ). Conclusion. Entecavir combined with adefovir dipivoxil in the treatment of hepatitis B cirrhosis can effectively improve the therapeutic effect and reduce the serum inflammatory factor levels, with high safety, which is worthy of application and popularization.

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Aspirin Reduces the Incidence of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B Receiving Oral Nucleos(t)ide Analog

Cited by 21 publications

References 28 publications

Systematic review with meta‐analysis: The effects of non‐steroidal anti‐inflammatory drugs and anti‐platelet therapy on the incidence and recurrence of hepatocellular carcinoma

Systematic review with meta‐analysis: The effects of non‐steroidal anti‐inflammatory drugs and anti‐platelet therapy on the incidence and recurrence of hepatocellular carcinoma

Statin and aspirin for chemoprevention of hepatocellular carcinoma: Time to use or wait further?

Effect of Entecavir Combined with Adefovir Dipivoxil on Clinical Efficacy and TNF-α and IL-6 Levels in Patients with Hepatitis B Cirrhosis

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