Document Detail


Maintenance peginterferon therapy and other factors associated with hepatocellular carcinoma in patients with advanced hepatitis C.
MedLine Citation:
PMID:  21129375     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Interferon reportedly decreases the incidence of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial showed that 4 years of maintenance therapy with pegylated interferon (peginterferon) does not reduce liver disease progression. We investigated whether peginterferon decreases the incidence of HCC in the HALT-C cohort over a longer posttreatment follow-up period.
METHODS: The study included 1048 patients with chronic hepatitis C (Ishak fibrosis scores ≥ 3) who did not have a sustained virologic response (SVR) to therapy. They were randomly assigned to groups given a half-dose of peginterferon or no treatment (controls) for 3.5 years and followed up for a median of 6.1 (maximum, 8.7) years.
RESULTS: Eighty-eight patients developed HCC (68 definite, 20 presumed): 37 of 515 who were given peginterferon (7.2%) and 51 of 533 controls (9.6%; P = .24). There was a significantly lower incidence of HCC among patients given peginterferon therapy who had cirrhosis, but not fibrosis, based on analysis of baseline biopsy samples. After 7 years, the cumulative incidences of HCC in treated and control patients with cirrhosis were 7.8% and 24.2%, respectively (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.24-0.83); in treated and control patients with fibrosis, incidences were 8.3% and 6.8%, respectively (HR, 1.44; 95% CI, 0.77-2.69). Treated patients with a ≥ 2-point decrease in the histologic activity index, based on a follow-up biopsy, had a lower incidence of HCC than those with unchanged or increased scores (2.9% vs 9.4%; P = .03).
CONCLUSIONS: Extended analysis of the HALT-C cohort showed that long-term peginterferon therapy does not reduce the incidence of HCC among patients with advanced hepatitis C who did not achieve SVRs. Patients with cirrhosis who received peginterferon treatment had a lower risk of HCC than controls.
Authors:
Anna S Lok; James E Everhart; Elizabeth C Wright; Adrian M Di Bisceglie; Hae-Young Kim; Richard K Sterling; Gregory T Everson; Karen L Lindsay; William M Lee; Herbert L Bonkovsky; Jules L Dienstag; Marc G Ghany; Chihiro Morishima; Timothy R Morgan;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2010-12-01
Journal Detail:
Title:  Gastroenterology     Volume:  140     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-07     Completed Date:  2011-05-09     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  840-9; quiz e12     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA. aslok@umich.edu
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00006164
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MeSH Terms
Descriptor/Qualifier:
Adult
Antiviral Agents / administration & dosage*
Biopsy
Carcinoma, Hepatocellular / epidemiology,  prevention & control*,  virology
Disease Progression
Drug Administration Schedule
Female
Hepacivirus / genetics
Hepatitis C, Chronic / complications,  diagnosis,  drug therapy*,  epidemiology
Humans
Incidence
Interferon-alpha / administration & dosage*
Kaplan-Meier Estimate
Liver Cirrhosis / diagnosis,  drug therapy*,  epidemiology,  virology
Liver Neoplasms / epidemiology,  prevention & control*,  virology
Male
Middle Aged
Polyethylene Glycols / administration & dosage*
Proportional Hazards Models
RNA, Viral / blood
Recombinant Proteins
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States / epidemiology
Viral Load
Grant Support
ID/Acronym/Agency:
1 UL1 RR 025780-01/RR/NCRR NIH HHS; 1 UL1 RR024986/RR/NCRR NIH HHS; 1 UL1 RR025758-01/RR/NCRR NIH HHS; M01RR-00042/RR/NCRR NIH HHS; M01RR-00043/RR/NCRR NIH HHS; M01RR-00051/RR/NCRR NIH HHS; M01RR-00065/RR/NCRR NIH HHS; M01RR-00633/RR/NCRR NIH HHS; M01RR-00827/RR/NCRR NIH HHS; M01RR-01066/RR/NCRR NIH HHS; M01RR-06192/RR/NCRR NIH HHS; N01 DK092323/DK/NIDDK NIH HHS; N01-DK-9-2318/DK/NIDDK NIH HHS; N01-DK-9-2319/DK/NIDDK NIH HHS; N01-DK-9-2320/DK/NIDDK NIH HHS; N01-DK-9-2321/DK/NIDDK NIH HHS; N01-DK-9-2322/DK/NIDDK NIH HHS; N01-DK-9-2323/DK/NIDDK NIH HHS; N01-DK-9-2324/DK/NIDDK NIH HHS; N01-DK-9-2325/DK/NIDDK NIH HHS; N01-DK-9-2326/DK/NIDDK NIH HHS; N01-DK-9-2327/DK/NIDDK NIH HHS; N01-DK-9-2328/DK/NIDDK NIH HHS; RR024982-01/RR/NCRR NIH HHS; UL1 RR024986-02/RR/NCRR NIH HHS; UL1 RR024986-03/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Antiviral Agents; 0/Interferon-alpha; 0/Polyethylene Glycols; 0/RNA, Viral; 0/Recombinant Proteins; 0/peginterferon alfa-2a; 76543-88-9/interferon alfa-2a
Comments/Corrections
Comment In:
J Hepatol. 2012 Jan;56(1):276-8   [PMID:  21782763 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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