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Title: | Sustained virologic response to direct-acting antiviral therapy in patients with chronic hepatitis C and hepatocellular carcinoma: A systematic review and meta-analysis | Authors: | 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 B. Kanai, Takanori Dang, Shuangsuo Li, Zongfang Dufour, Jean-Francois Zoulim, Fabien Andreone, Pietro Cheung, Ramsey C. Tanaka, Yasuhito Furusyo, Norihiro Toyoda, Hidenori Tamori, Akihiro Nguyen, Mindie H. |
Issue Date: | 2019 | Publisher: | ELSEVIER | Source: | JOURNAL OF HEPATOLOGY, 71(3), p. 473-485 | Abstract: | 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%, I-2 = 79.1% vs. 93.3%, 95% CI 91.9-94.7%, I-2 = 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 (I-2 = 84.7%, p <0.001). The SVR rate was similar in patients with/without HCC who were treated with ombitasvir/paritaprevir/ritonavi r +/- 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 (direct-acting antivirals or "DAAs") that can "cure" hepatitis C virus, but patients with hepatitis C and liver cancer may be less likely to achieve cure than those without liver cancer. However, patients with liver cancer are also more likely to have advanced liver disease and risk factors that can decrease cure rates, so better controlled studies are needed to confirm these findings. (C) 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. | Notes: | [Ji, Fanpu; Wang, Wenjun; Dang, Shuangsuo] Xi An Jiao Tong Univ, Dept Infect Dis, Affiliated Hosp 2, Xian, Shaanxi, Peoples R China. [Ji, Fanpu; Yeo, Yee Hui; Wei, Mike Tzuhen; Ogawa, Eiichi; Lee, Dong Hyun; Wei, Bin; Henry, Linda; Cheung, Ramsey C.; Nguyen, Mindie H.] Stanford Univ, Div Gastroenterol & Hepatol, Med Ctr, 750 Welch Rd,Suite 210, Palo Alto, CA 94304 USA. [Ji, Fanpu; Li, Zongfang] Xi An Jiao Tong Univ, Natl & Local Joint Engn Res Ctr Biodiag & Biother, Affiliated Hosp 2, Xian, Shaanxi, Peoples R China. [Ji, Fanpu; Li, Zongfang] Xi An Jiao Tong Univ, Shaanxi Prov Clin Res Ctr Hepat & Splen Dis, Affiliated Hosp 2, Xian, Shaanxi, Peoples R China. [Ogawa, Eiichi; Furusyo, Norihiro] Kyushu Univ Hosp, Dept Gen Internal Med, Fukuoka, Fukuoka, Japan. [Enomoto, Masaru; Tamori, Akihiro] Osaka City Univ, Dept Hepatol, Grad Sch Med, Osaka, Japan. [Lee, Dong Hyun] Good Gang An Hosp, Dept Internal Med, Div Gastroenterol, Busan, South Korea. [Iio, Etsuko; Tanaka, Yasuhito] Nagoya City Univ, Grad Sch Med Sci, Dept Virol, Nagoya, Aichi, Japan. [Iio, Etsuko; Tanaka, Yasuhito] Nagoya City Univ, Grad Sch Med Sci, Liver Unit, Nagoya, Aichi, Japan. [Lubel, John] Monash Univ, Eastern Hlth Clin Sch, Melbourne, Vic, Australia. [Ide, Tatsuya] Kurume Univ, Dept Med, Div Gastroenterol, Sch Med, Fukuoka, Fukuoka, Japan. [Preda, Carmen Monica] Univ Med & Pharm Carol Davila, Clin Inst Fundeni, Dept Gastroenterol & Hepatol, Bucharest, Romania. [Conti, Fabio; Andreone, Pietro] Univ Bologna, Res Ctr Study Hepatitis, Dept Med & Surg Sci, Bologna, Italy. [Minami, Tatsuya] Univ Tokyo, Grad Sch Med, Dept Gastroenterol, Tokyo, Japan. [Bielen, Rob] Hasselt Univ, Fac Med & Life Sci, Hasselt, Belgium. [Sezaki, Hitomi] Toranomon Gen Hosp, Dept Hepatol, Tokyo, Japan. [Barone, Michele] Univ Bari, Azienda Univ Osped Policlin, Dept Emergency & Organ Transplantat, Gastroenterol Unit, Bari, Italy. [Kolly, Philippe; Dufour, Jean-Francois] Univ Bern, Dept Clin Res, Bern, Switzerland. [Kolly, Philippe; Dufour, Jean-Francois] Inselspital Bern, Univ Clin Visceral Surg & Med, Bern, Switzerland. [Chu, Po-sung; Kanai, Takanori] Keio Univ, Dept Internal Med, Div Gastroenterol & Hepatol, Sch Med, Tokyo, Japan. [Virlogeux, Victor; Zoulim, Fabien] Hosp Civils Lyon, Grp Hosp Nord, Dept Hepatol, Lyon, France. [Eurich, Dennis] Campus Virchow Klinikum, Campus Charite Mitte, Dept Surg, Berlin, Germany. [Bass, Michelle B.] Stanford Univ, Lane Med Lib, Palo Alto, CA 94304 USA. [Bass, Michelle B.] Stanford Univ, Knowledge Management Ctr, Palo Alto, CA 94304 USA. [Zoulim, Fabien] Lyon Univ, CRCL, INSERM, U1052, Lyon, France. [Cheung, Ramsey C.] Vet Affairs Palo Alto Hlth Care Syst, Div Gastroenterol & Hepatol, Palo Alto, CA USA. [Toyoda, Hidenori] Ogaki Municipal Hosp, Dept Gastroenterol, Ogaki, Japan. | Keywords: | Asian;Non-Asian;Liver transplant;Real-world analysis;HCC treatment | Document URI: | http://hdl.handle.net/1942/30135 | ISSN: | 0168-8278 | e-ISSN: | 1600-0641 | DOI: | 10.1016/j.jhep.2019.04.017 | ISI #: | 000481571400005 | Rights: | 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2020 |
Appears in Collections: | Research publications |
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