SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2017/12  
 
  2017 Dec;67(6):1204-1212.  
  doi: 10.1016/j.jhep.2017.07.025.  
 
  Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: A systematic review, meta-analyses, and meta-regression  
 
  Waziry R, Hajarizadeh B, Grebely J, Amin J, Law M, Danta M, George J, Dore GJ  
  https://www.ncbi.nlm.nih.gov/pubmed/28802876  
 
 

Abstract

BACKGROUND & AIMS:

The risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy remains unclear. The aims of this study were to compare the rate of HCC occurrence in patients with HCV-related cirrhosis, following DAA vs. interferon (IFN)-based cure, and to compare the rate of HCC recurrence in patients who received curative HCC treatment, following DAA vs. IFN-based cure.

METHODS:

A search was conducted for reports published between January 2000 and February 2017. Studies were included if they assessed HCC outcomes by type and response to HCV therapy. Random-effects meta-analyses were undertaken to determine a combined estimate of HCC incidence rate per 100/person-years (py) among patients with a sustained virological response (SVR).

RESULTS:

A total of 41 studies (n=13,875 patients), including 26 on HCC occurrence (IFN=17, DAA=9; prospective=19, retrospective=5, retrospective-prospective=2), and 17 on HCC recurrence (IFN=7, DAA=10; prospective=11, retrospective=5 and retrospective-prospective=1) were included. In studies assessing HCC occurrence, average follow-up was shorter (1.0 vs. 5.5years), and average age older (60 vs. 52years) in DAA studies. In studies assessing HCC recurrence, average follow-up was shorter (1.3 vs. 5.0years), but average age similar (64 vs. 66years) in DAA studies. HCC occurrence was 1.14/100 py (95% CI 0.86-1.52) and 2.96/100 py (95% CI 1.76-4.96) in IFN and DAA studies respectively. HCC recurrence was 9.21/100 py (95% CI 7.18-11.81) and 12.16/100 py (95% CI 5.00-29.58) in IFN and DAA studies respectively. In meta-regression adjusting for study follow-up and age, DAA therapy was not associated with higher HCC occurrence (RR 0.68; 95% CI 0.18-2.55; p=0.55) or recurrence (RR 0.62, 95% CI 0.11-3.45, p=0.56).

CONCLUSION:

There is no evidence for differential HCC occurrence or recurrence risk following SVR from DAA and IFN-based therapy.

LAY SUMMARY:

The risk of hepatocellular carcinoma (HCC) occurrence or recurrence following direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy remains unclear. We conducted a meta-analysis to compare occurrence and recurrence of HCC in patients receiving either DAA or interferon (IFN) therapy. There is no evidence that HCC occurrence or recurrence is different between patients receiving DAA or IFN therapy.

  
Question posée
 
Comparer le taux de survenue d'un CHC chez des patients atteints de cirrhose liée au VHC, après un traitement par AAD ou interféron (IFN) et le taux de récidive de CHC chez des patients AAD vs. IFN.
  
Question posée
 
Absence de preuve d'occurrence différentielle de CHC ou de risque de récidive à la suite d'une RVS provenant d'un traitement à base d'AAD ou d'IFN.
  
Commentaires

Ce travail de synthèse portant sur 41 études, près de 14 000 patients !, devrait permettre (enfin) d’éteindre cette suspicion sur les traitements par AAD concernant le risque de CHC.
 
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