Sustained virologic response to direct-acting antiviral therapy in patients with chronic hepatitis C and hepatocellular carcinoma: A systematic review and meta-analysis
In: ISSN: 0168-8278, 2019
academicJournal
Zugriff:
International audience ; Background & aims: The effect of hepatocellular carcinoma (HCC) on the response to interferon-free direct-acting antiviral (DAA) therapy in patients with chronic hepatitis C (CHC) infection remains unclear. Using a systematic review and meta-analysis approach, we aimed to investigate the effect of DAA therapy on sustained virologic response (SVR) among patients with CHC and either active, inactive or no HCC.Methods: PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from 1/1/2013 to 9/24/2018. The pooled SVR rates were computed using DerSimonian-Laird random-effects models.Results: We included 49 studies from 15 countries, comprised of 3,341 patients with HCC and 35,701 without HCC. Overall, the pooled SVR was lower in patients with HCC than in those without HCC (89.6%, 95% CI 86.8-92.1%, I2 = 79.1% vs. 93.3%, 95% CI 91.9-94.7%, I2 = 95.0%, p = 0.0012), translating to a 4.8% (95% CI 0.2-7.4%) SVR reduction by meta-regression analysis. The largest SVR reduction (18.8%) occurred in patients with active/residual HCC vs. inactive/ablated HCC (SVR 73.1% vs. 92.6%, p = 0.002). Meanwhile, patients with HCC who received a prior liver transplant had higher SVR rates than those who did not (p <0.001). Regarding specific DAA regimens, patients with HCC treated with ledipasvir/sofosbuvir had lower SVR rates than patients without HCC (92.6%, n = 884 vs. 97.8%, n = 13,141, p = 0.026), but heterogeneity was high (I2 = 84.7%, p <0.001). The SVR rate was similar in patients with/without HCC who were treated with ombitasvir/paritaprevir/ritonavir ± dasabuvir (n = 101) (97.2% vs. 94.8%, p = 0.79), or daclatasvir/asunaprevir (91.7% vs. 89.8%, p = 0.66).Conclusion: Overall, SVR rates were lower in patients with HCC, especially with active HCC, compared to those without HCC, though heterogeneity was high. Continued efforts are needed to aggressively screen, diagnose, and treat HCC to ensure higher CHC cure rates.Lay summary: There are now medications ...
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Sustained virologic response to direct-acting antiviral therapy in patients with chronic hepatitis C and hepatocellular carcinoma: A systematic review and meta-analysis
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Autor/in / Beteiligte Person: | Ji, Fanpu ; Yeo, Yee Hui ; Wei, Mike Tzuhen ; Ogawa, Eiichi ; Enomoto, Masaru ; Lee, Dong Hyun ; Iio, Etsuko ; Lubel, John ; Wang, Wenjun ; Wei, Bin ; Ide, Tatsuya ; Preda, Carmen Monica ; Conti, Fabio ; Minami, Tatsuya ; Bielen, Rob ; Sezaki, Hitomi ; Barone, Michele ; Kolly, Philippe ; Chu, Po-Sung ; Virlogeux, Victor ; Eurich, Dennis ; Henry, Linda ; Bass, Michelle ; Kanai, Takanori ; Dang, Shuangsuo ; Li, Zongfang ; Dufour, Jean-François ; Zoulim, Fabien ; Andreone, Pietro ; Cheung, Ramsey ; Tanaka, Yasuhito ; Furusyo, Norihiro ; Toyoda, Hidenori ; Tamori, Akihiro ; Nguyen, Mindie ; Xi'an Jiaotong University (Xjtu) ; University, Stanford ; Kyushu Dental University Hospital ; Osaka City University (OCU) ; Nagoya City University Nagoya, Japan ; Monash University Melbourne ; Kurume University School of Medicine ; University, Kurume ; University of Medicine and Pharmacy “Carol Davila” Bucharest (UMPCD) ; Alma Mater Studiorum Università di Bologna = University of Bologna (UNIBO) ; The University of Tokyo (UTokyo) ; Hasselt University (UHasselt) ; Toranomon Hospital Tokyo, Japan ; Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA) ; Universität Bern / University of Bern (UNIBE) ; Keio University School of Medicine Tokyo, Japan ; HCL Groupement Hospitalier Nord Lyon ; Charité Campus Virchow-Klinikum (CVK) ; Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL) ; Centre Léon Bérard Lyon -Université Claude Bernard Lyon 1 (UCBL) ; Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS) |
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Zeitschrift: | ISSN: 0168-8278, 2019 |
Veröffentlichung: | HAL CCSD ; Elsevier, 2019 |
Medientyp: | academicJournal |
DOI: | 10.1016/j.jhep.2019.04.017 |
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