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Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis

Recent studies have suggested a negative impact of hepatocellular carcinoma (HCC) on sustained virologic response (SVR) to hepatitis C virus (HCV) direct acting antivirals (DAAs). We compared the effectiveness of DAAs in patients with cirrhosis, with and without HCC, and in those with HCC partially...

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Autores principales: Radhakrishnan, Kavita, Di Bisceglie, Adrian M., Reddy, K. Rajender, Lim, Joseph K., Levitsky, Josh, Hassan, Mohamed A., Darling, Jama M., Feld, Jordan J., Akushevich, Lucy, Vainorius, Monika, Nelson, David R., Fried, Michael W., Brown, Robert S., Terrault, Norah A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771159/
https://www.ncbi.nlm.nih.gov/pubmed/31592494
http://dx.doi.org/10.1002/hep4.1412
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author Radhakrishnan, Kavita
Di Bisceglie, Adrian M.
Reddy, K. Rajender
Lim, Joseph K.
Levitsky, Josh
Hassan, Mohamed A.
Darling, Jama M.
Feld, Jordan J.
Akushevich, Lucy
Vainorius, Monika
Nelson, David R.
Fried, Michael W.
Brown, Robert S.
Terrault, Norah A.
author_facet Radhakrishnan, Kavita
Di Bisceglie, Adrian M.
Reddy, K. Rajender
Lim, Joseph K.
Levitsky, Josh
Hassan, Mohamed A.
Darling, Jama M.
Feld, Jordan J.
Akushevich, Lucy
Vainorius, Monika
Nelson, David R.
Fried, Michael W.
Brown, Robert S.
Terrault, Norah A.
author_sort Radhakrishnan, Kavita
collection PubMed
description Recent studies have suggested a negative impact of hepatocellular carcinoma (HCC) on sustained virologic response (SVR) to hepatitis C virus (HCV) direct acting antivirals (DAAs). We compared the effectiveness of DAAs in patients with cirrhosis, with and without HCC, and in those with HCC partially treated or untreated (PT/UT‐HCC) versus completely treated (CT‐HCC). HCC status was based on imaging 6 months before or 2 months after start of DAA therapy. Absence and presence of enhancing lesions after HCC treatment defined CT‐HCC and PT/UT‐HCC, respectively. Using minimally adjusted logistic regression, the association between the presence of HCC and SVR rates was estimated. Among the 1,457 patients with cirrhosis from HCV‐TARGET with complete virologic data (per‐protocol population) who did not undergo liver transplantation during treatment and followup, 1,300 were without HCC, 91 with CT‐HCC, and 66 with PT/UT‐HCC. Most patients were genotype 1 (81%) and treatment‐experienced (56%), 41% had history of prior decompensation, and the median pretreatment Model for End‐Stage Liver Disease was 9 (range 6‐39). The SVR rates were 91% for patients without HCC, 84% for CT‐HCC, and 80% for PT/UT‐HCC. The presence of HCC (versus not having HCC) was associated with significantly lower odds of achieving SVR (odds ratio [OR] = 0.51, 95% confidence interval [CI]: 0.33‐0.81; P = 0.003). However, among those with HCC, HCC treatment status (PT/UT‐HCC versus CT‐HCC) did not show association with SVR (OR = 0.79, 95% CI: 0.35‐1.79, P = 0.569). Conclusions: The presence of HCC reduces the likelihood of SVR by 50%, but with no evident difference in those with completely treated HCC versus partially treated/untreated HCC.
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spelling pubmed-67711592019-10-07 Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis Radhakrishnan, Kavita Di Bisceglie, Adrian M. Reddy, K. Rajender Lim, Joseph K. Levitsky, Josh Hassan, Mohamed A. Darling, Jama M. Feld, Jordan J. Akushevich, Lucy Vainorius, Monika Nelson, David R. Fried, Michael W. Brown, Robert S. Terrault, Norah A. Hepatol Commun Original Articles Recent studies have suggested a negative impact of hepatocellular carcinoma (HCC) on sustained virologic response (SVR) to hepatitis C virus (HCV) direct acting antivirals (DAAs). We compared the effectiveness of DAAs in patients with cirrhosis, with and without HCC, and in those with HCC partially treated or untreated (PT/UT‐HCC) versus completely treated (CT‐HCC). HCC status was based on imaging 6 months before or 2 months after start of DAA therapy. Absence and presence of enhancing lesions after HCC treatment defined CT‐HCC and PT/UT‐HCC, respectively. Using minimally adjusted logistic regression, the association between the presence of HCC and SVR rates was estimated. Among the 1,457 patients with cirrhosis from HCV‐TARGET with complete virologic data (per‐protocol population) who did not undergo liver transplantation during treatment and followup, 1,300 were without HCC, 91 with CT‐HCC, and 66 with PT/UT‐HCC. Most patients were genotype 1 (81%) and treatment‐experienced (56%), 41% had history of prior decompensation, and the median pretreatment Model for End‐Stage Liver Disease was 9 (range 6‐39). The SVR rates were 91% for patients without HCC, 84% for CT‐HCC, and 80% for PT/UT‐HCC. The presence of HCC (versus not having HCC) was associated with significantly lower odds of achieving SVR (odds ratio [OR] = 0.51, 95% confidence interval [CI]: 0.33‐0.81; P = 0.003). However, among those with HCC, HCC treatment status (PT/UT‐HCC versus CT‐HCC) did not show association with SVR (OR = 0.79, 95% CI: 0.35‐1.79, P = 0.569). Conclusions: The presence of HCC reduces the likelihood of SVR by 50%, but with no evident difference in those with completely treated HCC versus partially treated/untreated HCC. John Wiley and Sons Inc. 2019-08-07 /pmc/articles/PMC6771159/ /pubmed/31592494 http://dx.doi.org/10.1002/hep4.1412 Text en © 2019 The Authors. Hepatology Communications published by Wiley Periodicals, Inc., on behalf of the American Association for the Study of Liver Diseases. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Radhakrishnan, Kavita
Di Bisceglie, Adrian M.
Reddy, K. Rajender
Lim, Joseph K.
Levitsky, Josh
Hassan, Mohamed A.
Darling, Jama M.
Feld, Jordan J.
Akushevich, Lucy
Vainorius, Monika
Nelson, David R.
Fried, Michael W.
Brown, Robert S.
Terrault, Norah A.
Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis
title Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis
title_full Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis
title_fullStr Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis
title_full_unstemmed Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis
title_short Treatment Status of Hepatocellular Carcinoma Does Not Influence Rates of Sustained Virologic Response: An HCV‐TARGET Analysis
title_sort treatment status of hepatocellular carcinoma does not influence rates of sustained virologic response: an hcv‐target analysis
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771159/
https://www.ncbi.nlm.nih.gov/pubmed/31592494
http://dx.doi.org/10.1002/hep4.1412
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