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Antiviral therapy for prevention of hepatocellular carcinoma in chronic hepatitis C: systematic review and meta-analysis of randomised controlled trials.

Kimer N, Dahl EK, Gluud LL, Krag A - BMJ Open (2012)

Bottom Line: Sequential analysis confirmed the overall result.There was clear statistical evidence of bias in the cohort studies (p=0.02).The effect may be seen irrespective of the virological response, but is more pronounced among virological responders compared with non-responders.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Gastroenterology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.

ABSTRACT

Objectives: To determine whether antiviral therapy reduces the risk of developing hepatocellular carcinoma (HCC) in chronic hepatitis C.

Design: Systematic review and meta-analyses of randomised controlled trials. Prospective cohort studies were included in sensitivity analyses.

Data sources: Eligible trials were identified through electronic and manual searches.

Study selection: Eight randomised controlled trials comparing antiviral therapy (interferon or pegylated interferon alone or with ribavirin) versus placebo or no intervention were included.

Data extraction and synthesis: Two independent reviewers assessed the methodological quality of studies and extracted data. Random effects meta-analyses were performed. Subgroup, sensitivity, regression and sequential analyses were performed to evaluate sources of intertrial heterogeneity, the risk of bias and the robustness of the results after adjusting for multiple testing.

Results: Random effects meta-analysis showed that antiviral therapy reduced the risk of HCC (81/1156 vs 129/1174; risk ratio 0.53, 95% CI 0.34 to 0.81). In subgroup analyses, antiviral therapy was more beneficial (test for subgroup differences p=0.03) in virological responders (0.15, 0.05 to 0.45) than in non-responders (0.57; 0.37 to 0.85). No evidence of bias was seen in regression analyses. Sequential analysis confirmed the overall result. The sensitivity analyses showed that the cohort studies found that antiviral therapy reduced the risk of HCC. There was clear statistical evidence of bias in the cohort studies (p=0.02).

Conclusions: Antiviral therapy may reduce the risk of HCC in hepatitis C-related fibrosis and cirrhosis. The effect may be seen irrespective of the virological response, but is more pronounced among virological responders compared with non-responders.

No MeSH data available.


Related in: MedlinePlus

Study selection flow chart.
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BMJOPEN2012001313F1: Study selection flow chart.

Mentions: The electronic searches generated 1711 references (figure 1). After reading the titles andabstracts, we identified 26 potentially relevant randomised controlled trials andobservational studies described in 27 references. Fourteen additional trials andreferences were identified through the manual searches. Twenty-four references wereretrospective cohort studies, case−control studies or trials that did notassess the risk of HCC. Eight randomised trials,1522–28 and fiveprospective cohort studies29–33 were included in our analyses.


Antiviral therapy for prevention of hepatocellular carcinoma in chronic hepatitis C: systematic review and meta-analysis of randomised controlled trials.

Kimer N, Dahl EK, Gluud LL, Krag A - BMJ Open (2012)

Study selection flow chart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4400677&req=5

BMJOPEN2012001313F1: Study selection flow chart.
Mentions: The electronic searches generated 1711 references (figure 1). After reading the titles andabstracts, we identified 26 potentially relevant randomised controlled trials andobservational studies described in 27 references. Fourteen additional trials andreferences were identified through the manual searches. Twenty-four references wereretrospective cohort studies, case−control studies or trials that did notassess the risk of HCC. Eight randomised trials,1522–28 and fiveprospective cohort studies29–33 were included in our analyses.

Bottom Line: Sequential analysis confirmed the overall result.There was clear statistical evidence of bias in the cohort studies (p=0.02).The effect may be seen irrespective of the virological response, but is more pronounced among virological responders compared with non-responders.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Gastroenterology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.

ABSTRACT

Objectives: To determine whether antiviral therapy reduces the risk of developing hepatocellular carcinoma (HCC) in chronic hepatitis C.

Design: Systematic review and meta-analyses of randomised controlled trials. Prospective cohort studies were included in sensitivity analyses.

Data sources: Eligible trials were identified through electronic and manual searches.

Study selection: Eight randomised controlled trials comparing antiviral therapy (interferon or pegylated interferon alone or with ribavirin) versus placebo or no intervention were included.

Data extraction and synthesis: Two independent reviewers assessed the methodological quality of studies and extracted data. Random effects meta-analyses were performed. Subgroup, sensitivity, regression and sequential analyses were performed to evaluate sources of intertrial heterogeneity, the risk of bias and the robustness of the results after adjusting for multiple testing.

Results: Random effects meta-analysis showed that antiviral therapy reduced the risk of HCC (81/1156 vs 129/1174; risk ratio 0.53, 95% CI 0.34 to 0.81). In subgroup analyses, antiviral therapy was more beneficial (test for subgroup differences p=0.03) in virological responders (0.15, 0.05 to 0.45) than in non-responders (0.57; 0.37 to 0.85). No evidence of bias was seen in regression analyses. Sequential analysis confirmed the overall result. The sensitivity analyses showed that the cohort studies found that antiviral therapy reduced the risk of HCC. There was clear statistical evidence of bias in the cohort studies (p=0.02).

Conclusions: Antiviral therapy may reduce the risk of HCC in hepatitis C-related fibrosis and cirrhosis. The effect may be seen irrespective of the virological response, but is more pronounced among virological responders compared with non-responders.

No MeSH data available.


Related in: MedlinePlus