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Antivirals cut liver cancer risk after hepatitis C

Liver cancer about half as likely after hep C if antivirals given

Louise Prime

Tuesday, 23 October 2012

Hepatocellular carcinoma is about half as likely after chronic hepatitis C infection in people who take antiviral therapy as in those who don’t take it, shows research published online on BMJ Open. People in whom the drugs completely cleared the virus had the greatest protection from liver cancer, but even people in whom antivirals were less effective were still somewhat protected.

Researchers analysed data from eight comparative treatment trials and five prospective cohort studies on the use of antiviral therapy in a total of more than 3200 people with chronic hepatitis C infection. The therapies were interferon or pegylated interferon, or ribavirin, or both, given over 6-12 months; follow up in the studies varied from 5-8 years.

Overall, the incidence of liver cancer during follow up was 47% lower in people who had had antiviral therapy than in those who had not had the therapy.

People in whom antiviral therapy had achieved long-term clearance of the hepatitis C virus were 85% less likely to develop liver cancer than people who had not had antiviral therapy. Even ‘non-responders’, in whom antiviral therapy had been less effective, were 43% less likely to develop liver cancer than people who had not taken antivirals at all.

Data from the cohort studies alone also showed that antiviral therapy curbed the risk of liver cancer: by 71% compared with no treatment.

The authors caution that because of the lack of long-term monitoring and mortality data, they cannot exclude the possibility that interferon delays rather than prevents carcinogenesis. They say further randomised studies are needed, with longer follow up, to examine the effect of antivirals on people’s susceptibility to hepatocellular carcinoma.

But they point out that current antiviral treatment is, if anything, likely to be more effective than that used in most of the trials they analysed. They conclude: “Most of the included trials assessed interferon monotherapy. Standard practice is pegylated interferon and ribavirin in combination, and direct extrapolation of the observed effects to clinical practice is difficult.

“The protection from [hepatocellular carcinoma] might be even better among patients in current antiviral therapy since the proportion of virological responders continues to increase with ongoing improvements in therapy. Also, today’s patients are diagnosed and treated earlier in the course of their disease.”

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