Averell H. Sherker, MD, FRCP(C)
Do interferon and nucleoside/tide analogues reduce risk for hepatocellular cancer (HCC) in patients with chronic hepatitis B virus (HBV) infection?
Included studies compared interferon, pegylated interferon, or nucleoside/tide analogues (lamivudine, adefovir, entecavir, and telbuvidine) with no antiviral treatment (in any study type) or placebo (in randomized controlled trials [RCTs]) in patients with confirmed chronic HBV infection. The outcome, chronic hepatitis B–related HCC had to be reported for both treatment and control groups.
MEDLINE (1950 to Dec 2007), EMBASE/Excerpta Medica (1980 to wk 48, 2007), Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effects (both Issue 3, 2007), International Pharmaceutical Abstracts (1970 to Nov 2007), abstracts from major international conferences in the past 10 years, and reference lists were searched for English-language RCTs, case–control studies, or cohort studies. 12 studies (n = 2742, mean age 37 y, follow-up 4.7 to 8.9 y) evaluated interferon, including 1 RCT, 1 case–control study, and 10 cohort studies. 5 studies (n = 2289, mean age 43 y based on 2067 patients, follow-up 2.7 to 8.2 y), including 2 RCTs, 1 case–control study, and 2 cohort studies, evaluated nucleoside/tide analogues; all used lamivudine, and 1 added adefovir for patients with lamivudine resistance. 10 studies had higher quality (scores of 3 or 4 out of 5).
Meta-analysis showed that interferon and nucleoside/tide analogues reduced risk for HCC more than placebo or no treatment (Table). Meta-analyses of subgroups showed that both treatments reduced risk for HCC in patients with early cirrhosis, and nucleoside/tide analogues reduced risk in patients without cirrhosis (Table).
Interferon and nucleoside/tide analogues reduce risk for hepatocellular cancer in patients with chronic hepatitis B.
Interferon (IFN) or nucleoside/tide analogues (NAs) vs placebo or no treatment to prevent hepatocellular cancer in patients with chronic hepatitis B infection*
*NS = not significant; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article using fixed-effect (IFN) and random-effect (NAs) models.
Sherker AH. Review: Interferon and nucleoside/tide analogues reduce risk for hepatocellular cancer in patients with chronic hepatitis B. Ann Intern Med. ;150:JC4–11. doi: 10.7326/0003-4819-150-8-200904210-02011
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Published: Ann Intern Med. 2009;150(8):JC4-11.
Gastroenterology/Hepatology, Hematology/Oncology, Infectious Disease, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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