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Failed HCV therapy increases risk for HCC

Patients with hepatitis C virus infection who failed interferon-based therapy have an increased risk for hepatocellular carcinoma compared with patients who achieved sustained virologic response, according to recently published data.

Mei Lu, PhD, of the department of public health sciences, Henry Ford Health System, Michigan, and colleagues evaluated the electronic medical records of 10,091 patients enrolled in the Chronic Hepatitis Cohort Study, an observational study comprising four different U.S. health systems that follows patients for 7 years. The goal was to determine how treatment failure compared with lack of treatment.

Mei Lu

“Although interferon-free regimens — including highly effective and well-tolerated direct-acting oral agents — are transforming the landscape of HCV antiviral treatment, understand the long-term impact of interferon therapy in the ‘real world’ will improve care for patients in the future,” the researchers wrote.

Thirty-six percent of the patients received treatment (n = 3,681), of which 57% experienced treatment failure (n = 2,099) and 43% achieved SVR (n = 1,582).

After inverse probability treatment weighting on multivariate and univariates analyses, patients who failed treatment showed nearly twice the risk for HCC compared with patients who did not receive treatment (adjusted HR = 1.95, 95% CI, 1.5–2.53). The risk for increased HCC among this population remained across all stages of fibrosis, according to the research.

Patients who achieved SVR had lower risk for HCC compared with patients who failed treatment (aHR = 0.48, CI 0.31–0.73). Overall treatment — regardless of outcome — reduced all-cause mortality for patients who achieved SVR (aHR = 0.45, CI 0.34–0.6) and patients who failed treatment (aHR = 0.78, CI 0.65–0.93).

"Through rigorous analyses, we found that HCV patients who received interferon-based therapy but failed to achieve sustained virological response had twice the risk of developing HCC compared with treatment-naive patients," Lu told Healio.com/Hepatology. "Regardless of whether this finding reflects an impaired innate immune responsiveness among patients with treatment failure, or an interferon-mediated acceleration of fibrosis, our findings suggest that treatment failure patients may represent a cohort of individuals for whom retreatment with new, highly effective direct-acting all-oral antiviral therapies should become a priority.” – by Melinda Stevens

Disclosure: Lu reports no relevant financial disclosures. Please see the full study for all other researchers’ relevant financial disclosures.