Treatment of hepatitis C virus (HCV) with direct-acting antivirals (DAAs) was tied to a 71% reduction in the risk of liver cancer, according to research presented at The Liver Meeting 2017.

Study authors from the University of Washington, Seattle, and Veterans Affairs Puget Sound Healthcare System in Seattle sought to investigate whether HCV eradication with DAAs could lower the risk of liver cancer in patients. They also wanted to compare clinical responses to DAA regimens vs. interferon-based regimens. 

For the study (n=62,051), patients who received the following antiviral regimens from 1999 to 2015 were included: interferon-only regimens, DAA±interferon regimens, and DAA-only regimens. Hazard regression models were used to calculate the association between HCV eradication and liver cancer risk after adjusting for potential confounders. 

A total of 3,271 incidences of liver cancer diagnosed ≥180 days after antiviral treatment initiation were identified; average follow-up was 6.1 years. The team found that liver cancer incidence was highest in patients with cirrhosis and treatment failure (3.25 per 100 patient-years). This was followed by presence of cirrhosis and sustained virological response (1.97 per 100 patient-years), no cirrhosis and treatment failure (0.87 per 100 patient-years), and no cirrhosis and sustained virological response (0.24 per 100 patient-years). 

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Sustained virological response correlated to a significantly lower risk of liver cancer in multivariable models no matter the type of antiviral treatment: DAA-only (adjusted hazard ratio [aHR] 0.29, 95% CI: 0.23–0.37), DAA+interferon (aHR 0.48, 95% CI: 0.32–0.73) or interferon-only (aHR 0.32, 95% CI: 0.28–0.37). Moreover, the risk of liver cancer was not higher among patients who received DAA-only or DAA+interferon vs. an interferon-only regimen.

Overall, a 71% reduction in liver cancer risk was seen with DAA-induced sustained virological response. The data also showed DAA treatment was not associated with a higher liver cancer risk compared to interferon-based treatment.  

George N. Ioannou, MD, MS, lead author of the study, stated ,”Physicians and patients should not be withholding antiviral treatment for fear of inducing liver cancer. On the contrary, physicians should be treating hepatitis C specifically to reduce the risk of liver cancer.”

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