Effectiveness of interferon alfa on incidence of hepatocellular carcinoma and decompensation in cirrhosis type C

Fattovich, Giovanna; Giustina, G.; Degos, Françoise; Diodati, G.; Tremolada, F.; Nevens, Frederik; Almasio, Piero Luigi; Solinas, Antonio; Brouwer, Johannes T.; Thomas, Howard; Realdi, Giuseppe; Corrocher, Roberto; Schalm, Solko W.

doi:10.1016/s0168-8278(97)80302-9

Cited by 189 publications

(96 citation statements)

References 8 publications

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“…Twenty-two studies (5 RCTs and 17 CSs) were eligible for meta-analysis [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42]. Detailed descriptions of the included studies are available in the online supplementary table 2.…”

Section: Resultsmentioning

confidence: 99%

A Critical Evaluation of the Preventive Effect of Antiviral Therapy on the Development of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C or B: A Novel Approach by Using Meta-Regression

Shen¹,

Hsu²,

Ченг

et al. 2012

Oncology

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Background: The extent of the effect of antiviral therapy and its predictors in preventing hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C (CHC) or B (CHB) remain unclear. Methods: We conducted a systemic review and meta-analysis of published randomized controlled trials (RCTs) and cohort studies (CSs) up to December 2010. Preventive efficacy was measured as absolute reduction in 3- and 5-year cumulative incidence of HCC with antiviral therapy. Predictors for efficacy were identified by using meta-regression. Results: Twenty-two studies (5 RCTs; 17 CSs) were included for analysis. Antiviral therapy reduced 5-year cumulative incidence of HCC by 7.8% (95% CI 4.6–11.1; p < 0.0001) in patients with CHC and by 7.1% (95% CI 4.1–10.2; p < 0.0001) in patients with CHB. The efficacy was significant as early as 3 years after antiviral therapy. While adjusting for available study-level, patient and virological factors, RCT and higher sustained virological response were identified as pertinent predictors of superior preventive efficacy in patients with CHC, whereas lower hepatitis B virus e antigen seropositivity was identified in patients with CHB. Antiviral therapy did not result in differential preventive efficacy between cirrhotic and noncirrhotic patients with CHC or CHB. Conclusion: Antiviral therapy can reduce 3- and 5-year cumulative incidence of HCC in patients with CHC or CHB.

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Section: Resultsmentioning

confidence: 99%

A Critical Evaluation of the Preventive Effect of Antiviral Therapy on the Development of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C or B: A Novel Approach by Using Meta-Regression

Shen¹,

Hsu²,

Ченг

et al. 2012

Oncology

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“…Thus Hepatitis C infection is an important cause of chronic liver it is difficult to use prognostic indicators to deny therapy, disease and primary hepatocellular carcinoma in many parts and withholding a potentially useful treatment for a progresof the world. 1,2 In the United States, there are an estimated sive viral disease may not be acceptable to patients who have 3.9 million carriers of hepatitis C, approximately 30,000 new chronic hepatitis C. In 1991, we began to use the recommended dosing schedule of 3 million units of interferon alfa 2b three times a week Abbreviations: ALT, alanine transaminase; CBC, complete blood count; HCV, hepafor 24 weeks in treatment of hepatitis C patients at two titis C virus; IVDA, intravenous drug abuse; RT-PCR, reverse transcription-polymerase institutions in Southern California. To determine which endchain reaction.…”

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confidence: 99%

Prediction of response during interferon alfa 2b therapy in chronic hepatitis C patients using viral and biochemical characteristics: A comparison

et al. 1997

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Patients with chronic hepatitis C (n = 103) were treated for 24 weeks with interferon alfa 2b and followed up for 24 weeks after cessation of therapy (week 48). When hepatitis C virus (HCV) RNA at week 48 was used to assess interferon response, 15 (14.6%) were virological complete responders, and all have remained HCV RNA negative for a mean of 3 years. At week 48, 3 of 15 virological complete responders had elevated alanine transaminase (ALT) values. When serum ALT level was used at week 48 to determine response to interferon, 20 (19.4%) were biochemical complete responders. However, 8 of the 20 patients with normal ALT levels were HCV RNA positive at week 48, and 7 of these individuals have had a recurrence of elevated ALT levels within 3 years after cessation of treatment. These findings indicate that measurement of HCV RNA was more accurate than ALT in determining true responses to interferon therapy. Identification of nonresponders early during the course of interferon treatment showed that an elevated ALT level at week 12 was 92% predictive (odds ratio 3.7) but misidentified 33% (5 of 15) of the patients who were virological complete responders at week 48. In contrast, a positive HCV RNA at week 12 of treatment was 98% predictive (odds ratio 35.5) and misidentified only 6.7% (1 of 15) of the virological complete responders. Thus, positive HCV RNA at week 12 of therapy was more accurate in identifying eventual virological nonresponders than measurement of ALT at this time. Termination of interferon therapy in patients who were HCV RNA positive at week 12 would result in a 27% reduction in the direct medical costs and keep patients from undergoing unnecessary treatment. Therefore, testing for HCV RNA at week 12 to identify nonresponders and then discontinuing their treatment is practical, cost-efficient and beneficial both to patients and to third-party payers.

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“…Further studies of effects of therapy with alpha interferon in patients with cirrhosis caused by hepatitis C has been assessed in one pro-larger numbers of responders and longer follow-up evaluation are needed to prove that HCV clearance and subsequent spective and two large retrospective studies comprising 703 patients. [5][6][7] In these studies, the major focus was on whether decrease in hepatic inflammation and necrosis are associated with a significant reduction in the incidence of HCC. interferon therapy reduced the incidence of HCC.…”

mentioning

confidence: 99%

“…In a study of European patients, Fattovich et al 6 analyzed prognostic factors using the Cox regression model and eficial effects of interferon therapy on survival and development of HCC in patients with cirrhosis caused by hepatitis multivariate analyses; after adjustment for clinical and serologic differences among patients at entry, the estimated 5-C were probably a result of differences in patient characteristics at entry into the studies. Thus, the effects of interferon year probability of HCC occurrence was similar for interferon-treated and untreated patients.…”

mentioning

confidence: 99%

Therapy of hepatitis C: Patients with cirrhosis

1997

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The management of both compensated and decompensated progressed to cirrhosis is estimated to be 20% to 30%. 1 In addition to patients who present with symptoms or signs cirrhosis caused by hepatitis C must be viewed in the context of the natural history of the disease. The prognosis of compen-of chronic hepatitis C, a proportion present initially with complications of cirrhosis such as variceal bleeding, ascites, sated cirrhosis caused by hepatitis C is relatively good. In a recent retrospective study, after 5 years of follow-up evalua-or hepatocellular carcinoma (HCC). For countries in North America and Europe with a prevalence of chronic HCV infection, 18% of patients had developed hepatic decompensation and 7% hepatocellular carcinoma. Overall 5-year survival rate tion in the general population of 0.5% to 2%, one can estimate that at least 0.1% (1,000 per million) of the population was 91%. Treatment with alpha interferon appears to decrease the incidence of hepatocellular carcinoma in patients who have cirrhosis caused by hepatitis C.Spontaneous resolution of disease and loss of viral replicaachieve a sustained remission. However, on an intention-totreat basis and after adjustment for differences in clinical tion is rare during the course of chronic hepatitis C. 2 Accordingly, patients with cirrhosis caused by HCV are likely to and serological features at entry, interferon therapy does not correlate with a reduced incidence of liver cancer or improved progress steadily, eventually developing complications of hepatic failure or HCC or require liver transplantation. Death survival. Combined analysis of multiple large studies on patients with cirrhosis caused by hepatitis C indicates that cur-from liver-related causes has been shown to account for 70% of the mortality in patients with cirrhosis caused by hepatitis rent regimens of alpha interferon (3 to 6 million units three times weekly for 6 to 12 months) result in a sustained bio-C, 3 compared with only 3% of patients overall with hepatitis C. 4 The patient with cirrhosis caused by hepatitis C constichemical response in 9% of patients. The rates of sustained virological responses are less well documented. Virological tutes an important therapeutic challenge.The management of both compensated and decompenmeasurements during therapy show that only 22% of patients become hepatitis C virus (HCV) RNA negative by 4 weeks sated cirrhosis should be viewed in the context of the natural history of the disease. Recent reports have suggested that and, thereafter, there is a high rate of breakthrough. In small studies, the combination of interferon and ribavirin leads to alpha interferon therapy may reduce the risk of HCC in patients with cirrhosis. 5 At the same time, interferon is rarely sustained biochemical and virological response rates of 21%, more than twice the rates achieved with interferon alone. The effective in inducing lasting remissions in patients with preexisting cirrhosis. Thus, the role of alpha interferon therapy prognosis of decompensated cirrhosis c...

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Effectiveness of interferon alfa on incidence of hepatocellular carcinoma and decompensation in cirrhosis type C

Cited by 189 publications

References 8 publications

A Critical Evaluation of the Preventive Effect of Antiviral Therapy on the Development of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C or B: A Novel Approach by Using Meta-Regression

A Critical Evaluation of the Preventive Effect of Antiviral Therapy on the Development of Hepatocellular Carcinoma in Patients with Chronic Hepatitis C or B: A Novel Approach by Using Meta-Regression

Prediction of response during interferon alfa 2b therapy in chronic hepatitis C patients using viral and biochemical characteristics: A comparison

Therapy of hepatitis C: Patients with cirrhosis

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