Maintenance peginterferon therapy and other factors associated with hepatocellular carcinoma in patients with advanced hepatitis C
| Autor: | Richard K. Sterling, Gregory T. Everson, Elizabeth C. Wright, Adrian M. Di Bisceglie, Marc G. Ghany, Herbert L. Bonkovsky, James E. Everhart, Chihiro Morishima, Jules L. Dienstag, William M. Lee, Karen L. Lindsay, Timothy R. Morgan, Hae-Young Kim, Anna S. Lok |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Liver Cirrhosis Male medicine.medical_specialty Cirrhosis Carcinoma Hepatocellular Time Factors Biopsy Hepacivirus Kaplan-Meier Estimate Interferon alpha-2 Lower risk Gastroenterology Antiviral Agents Risk Assessment Drug Administration Schedule Polyethylene Glycols Liver disease Maintenance therapy Pegylated interferon Risk Factors Internal medicine medicine Humans Proportional Hazards Models Hepatology business.industry Incidence Liver Neoplasms Interferon-alpha Hepatitis C Hepatitis C Chronic Middle Aged Viral Load medicine.disease Recombinant Proteins United States Treatment Outcome Hepatocellular carcinoma Immunology Disease Progression RNA Viral Female business Liver cancer medicine.drug |
| Zdroj: | Gastroenterology. 140(3) |
| ISSN: | 1528-0012 |
| Popis: | Background & Aims Interferon reportedly decreases the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial showed that 4 years of maintenance therapy with pegylated interferon (peginterferon) does not reduce liver disease progression. We investigated whether peginterferon decreases the incidence of HCC in the HALT-C cohort over a longer posttreatment follow-up period. Methods The study included 1048 patients with chronic hepatitis C (Ishak fibrosis scores ≥3) who did not have a sustained virologic response (SVR) to therapy. They were randomly assigned to groups given a half-dose of peginterferon or no treatment (controls) for 3.5 years and followed up for a median of 6.1 (maximum, 8.7) years. Results Eighty-eight patients developed HCC (68 definite, 20 presumed): 37 of 515 who were given peginterferon (7.2%) and 51 of 533 controls (9.6%; P = .24). There was a significantly lower incidence of HCC among patients given peginterferon therapy who had cirrhosis, but not fibrosis, based on analysis of baseline biopsy samples. After 7 years, the cumulative incidences of HCC in treated and control patients with cirrhosis were 7.8% and 24.2%, respectively (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.24–0.83); in treated and control patients with fibrosis, incidences were 8.3% and 6.8%, respectively (HR, 1.44; 95% CI, 0.77–2.69). Treated patients with a ≥2-point decrease in the histologic activity index, based on a follow-up biopsy, had a lower incidence of HCC than those with unchanged or increased scores (2.9% vs 9.4%; P = .03). Conclusions Extended analysis of the HALT-C cohort showed that long-term peginterferon therapy does not reduce the incidence of HCC among patients with advanced hepatitis C who did not achieve SVRs. Patients with cirrhosis who received peginterferon treatment had a lower risk of HCC than controls. |
| Databáze: | OpenAIRE |
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