HBV: COX inhibitors tied to lower risk for liver cancer

  • Cho KS & al.
  • J Viral Hepat
  • 10 Sep 2019

  • International Clinical Digest
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Takeaway

  • Use of cyclooxygenase (COX) inhibitors is tied to a decreased risk for hepatocellular carcinoma (HCC) in patients with HBV.
  • The effect appears to be dose dependent.

Why this matters

  • COX expression in cancer tissues varies from 40% to 100%, and evidence suggests that COX-2 inhibition plays a chemopreventive role in colon, breast, prostate, and lung cancer.

Study design

  • Nested case-control study of 4980 HBV-infected patients from the Korean National Health Insurance Service-National Sample Cohort (2002-2013).
  • 996 patients with HCC were matched with 3984 control patients based on clinical and demographic factors; mean age was 51.2 years.
  • COX inhibitor use was stratified by cumulative defined daily dose (cDDD) 360 mg.
  • Funding: None.

Key results

  • COX inhibitors were used (≥28 cDDD) by 35.9% of patients with HCC and 45.5% of control patients; mean follow-up was 4.63 and 5.06 years, respectively.
  • Exposure to COX inhibitors was tied to a 38% reduced odds of HCC development (aOR, 0.62; P<.001>
  • Odds of HCC generally declined with increasing cDDD:
    • 28-90 mg: 25% risk reduction (aOR, 0.75; P=.002).
    • 91-180 mg: 59% risk reduction (aOR, 0.41; P<.001>
    • 181-360 mg: 62% risk reduction (aOR, 0.38; P<.001>
    • >360 mg: 51% risk reduction (aOR, 0.49; P=.003).

Limitations

  • Observational design.
  • Clinical data were not captured by claim information.
  • Low use of selective COX-2 inhibitors (2.3%-2.8%).