Hepatocellular Carcinoma Recurrence in Patients with Chronic Hepatitis C Infection Treated with Direct-Acting...

Reports of direct-acting antivirals (DAA) use for chronic hepatitis C virus (HCV) infection after successful treatment of hepatocellular carcinoma (HCC) have suggested higher rates of HCC recurrence. However, other studies have indicated no increased risk of HCC recurrence.

To estimate the comparative risk of early HCC recurrence in adults successfully treated for HCC and subsequently treated with interferon (IFN)-free DAAs versus not treated with DAAs for chronic HCV, we conducted a systematic literature review and meta-analysis following established guidelines.

Forty-one cohort studies (10,563 total participants) were identified. The following mutually exclusive comparisons to DAA therapy were determined: IFN-based therapy; no DAA; and no antiviral therapy. Random effects meta-analysis results indicated no increased risk of HCC recurrence with IFN-free DAA therapy when compared with IFN (combined risk ratio (RR) 1.29 [95% CI 0.69, 2.40] at 12 months, 0.88 [95% CI 0.56, 1.39] at 24 months, and 0.67 [95% CI 0.51, 0.88] at longest follow-up), no DAA (combined RR 0.55 [95% CI 0.25, 1.23] at 12 months, 0.67 [95% CI 0.51, 0.86] at 24 months and 0.72 [95% CI 0.61, 0.85] at longest follow-up), or no antiviral therapy (combined RR 0.95 [95% CI 0.76, 1.20] at 12 months, 0.48 [95% CI 0.11, 2.12] at 24 months, and 0.42 [95% CI 0.24, 0.73] at longest follow-up). Results were confirmed in sensitivity analyses.

There is no evidence to suggest that DAA therapy has a higher risk of early HCC recurrence when compared with IFN, no DAA, or no antiviral therapy at any timepoint analyzed. Hence the benefit-risk profile of DAAs in HCV remains positive in relation to the risk of early HCC recurrence.