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Carvedilol versus Propranolol in Patients with Hepatocellular Carcinoma: A Nationwide Cohort Study

Byeong Geun Song1, Myeongcheol Lee2,3, Juhee Cho2,3

  • 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Liver Cancer
|August 11, 2026
PubMed

Insights

Carvedilol use in hepatocellular carcinoma (HCC) patients significantly lowered hepatic decompensation and all-cause mortality compared to propranolol. These findings suggest carvedilol may be a preferred beta-blocker for HCC management.

Area of Science:

  • Hepatology
  • Pharmacology
  • Clinical Medicine

Background:

  • Beta-blockers are used to manage portal hypertension.
  • Limited evidence exists comparing carvedilol and propranolol in hepatocellular carcinoma (HCC) patients.

Purpose of the Study:

  • To compare the clinical outcomes of carvedilol versus propranolol in patients diagnosed with HCC.
  • To evaluate the efficacy of carvedilol against propranolol in reducing mortality and hepatic decompensation in HCC patients.

Main Methods:

  • Retrospective cohort study using the Korean National Health Insurance Service database (2009-2023).
  • Identified 11,124 newly diagnosed HCC patients prescribed carvedilol or propranolol.
  • Utilized multivariable Cox regression and propensity score (PS) matching, with sensitivity analyses.

Main Results:

  • Carvedilol use was associated with significantly lower risks of hepatic decompensation (aHR 0.67) and all-cause mortality (aHR 0.84) compared to propranolol.
  • Results were consistent in the 1:2 PS-matched cohort and across various subgroups.
  • Sensitivity analyses excluding early deaths and using a new-user design confirmed these benefits.

Conclusions:

  • Carvedilol demonstrated superior outcomes in HCC patients, showing better survival and reduced hepatic decompensation compared to propranolol.
  • Carvedilol may be the preferred beta-blocker choice for patients with HCC.
Abstract

Keywords:
CarvedilolHepatocellular carcinomaHypertensionPortalPropranolol

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