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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...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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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. |
format | Online Article Text |
id | pubmed-6771159 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
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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