HCV: DAA-induced clearance less likely with liver cancer

  • J Hepatol
  • 13 May 2019

  • International Clinical Digest
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Takeaway

  • HCV direct-acting antivirals (DAAs) appear less effective in patients with hepatocellular carcinoma (HCC), particularly among those with active or residual disease.

Why this matters

  • Reduced HCV clearance may be due in part to more advanced fibrosis, underscoring the value of early diagnosis and treatment.

Study design

  • Meta-analysis of 49 studies from 15 countries, involving 39,042 patients receiving DAAs during 2013-2018; 3341 (8.6%) had HCC.
  • Primary endpoint: sustained virologic response >12 weeks posttreatment (SVR12) with and without HCC.
  • Funding: None disclosed.

Key results

  • Pooled SVR12 was lower in patients with HCC (89.6% vs no HCC, 93.3%; P=.0012), corresponding to a 4.8% difference (95% CI, 0.2%-7.4%).
  • In HCC:
    • Active/residual disease was associated with an 18.8% lower SVR12 rate vs inactive/ablated HCC (73.1% vs 92.6%; P=.002).
    • Prior liver transplant was associated with higher SVR12 (96.7% vs 90.3%; P<.001>
  • Efficacy by regimen:
    • Sofosbuvir (Sovaldi)-based regimens: lower SVR12 in HCC (86.7% vs 94.6%; P<.0001>
    • Ledipasvir/sofosbuvir (Harvoni): lower SVR12 in HCC (92.6% vs 97.8%; P=.026), with high heterogeneity (I2=84.7%).
    • Paritaprevir/ritonavir, ombitasvir±dasabuvir (Viekira): similarly effective with/without HCC (97.2% vs 94.8%; P=.79), but sample size was small (n=101).
    • Daclatasvir/asunaprevir (Daklinza/Sunvepra): similarly low efficacy with/without HCC (91.7% vs 89.8%; P=.66); asunaprevir is not FDA-approved.

Limitations

  • No HCC subanalysis by cirrhosis status.

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