The risks of hepatocellular carcinoma development after HCV eradication are similar between patients treated with peg-interferon plus ribavirin and direct-acting antiviral therapy

Abstract

The risk of hepatocellular carcinoma (HCC) development is reduced following viral elimination by interferon therapy in chronic hepatitis C patients. However, the risk in patients treated with interferon-free direct-acting antivirals (DAAs) is unknown. We evaluated chronic hepatitis C patients who achieved viral eradication by pegylated-interferon plus ribavirin (PEG-IFN/RBV, n = 244) or daclatasvir plus asunaprevir (DCV/ASV, n = 154) therapy. None of the patients had prior history of HCC or antiviral therapy. The median observation period after the end of treatment for the PEG-IFN/RBV and DCV/ASV groups were 96 (range 10–196) and 23 (range 4–78) months, respectively. During the observation period, HCC developed in 13 (5.3%) and 7 (4.5%) patients in the PEG-IFN/RBV and DCV/ASV groups, respectively. The cumulative HCC development rate after 1-, 3- and 5-years (0.4%, 3% and 5% for the PEG-IFN/RBV group and 0.6%, 9% and 9% for the DAA group, respectively) were similar between the two groups. Propensity score matching analysis also showed no significant difference in HCC development rates between the two groups. Serum AFP levels decreased to similar levels between PEG-IFN/RBV and DCV/ASV groups following the achievement of viral eradication. The risk for HCC development following viral eradication by IFN-free DAA therapy may be similar to that in IFN-based therapy.

Hepatocellular carcinoma occurrence does not differ between interferon‐based and interferon‐free treatment with liver histological assessment

“…As the baseline characteristics of the patients differed between the two groups, we used PS matching to resolve these differences. Two studies compared the occurrence rate of HCC between patients receiving IFN‐based and IFN‐free treatments by using PS matching . In these studies, assessments of liver histology, which is a gold standard diagnostic tool for evaluating liver fibrosis, were not considered.…”

“…More factors included in the analysis can achieve greater accuracy, but require more patients. In previous studies using PS matching, platelet count or Fibrosis‐4 index was included as an index of liver fibrosis, although the stage of liver fibrosis by liver biopsy was not considered as a variable, and the number of patients before PS matching was small …”

Proposed a simple score for recommendation of scheduled ultrasonography surveillance for hepatocellular carcinoma after Direct Acting Antivirals: multicenter analysis

“…Recently, the risk of HCC occurrence following treatment with DAAs was reported to be 2.96/100 patients per year, while Kanwal noted that no evidence was found to suggest that DAAs promote HCC in a large study of 22 500 patients . More recently, no evidence for differential HCC occurrence risk following SVR between DAA and IFN‐based therapy was found . On the other hand, although the risk of HCC after achieving SVR has been reported to be high in patients with established LC, an easy and simple strategy for determination of those with high risk for development of HCC after reaching SVR24 with DAA therapy is required.…”

The impact of interferon‐free direct‐acting antivirals on clinical outcome after curative treatment for hepatitis C virus–associated hepatocellular carcinoma: Comparison with interferon‐based therapy

“…Recent reports have shown that the incidence of HCC was reduced after eradication of HCV in patients treated with DAAs . Furthermore, Ikeda et al reported on HCC recurrence rates in patients after curative treatment for HCC who had and had not received antiviral therapy.…”