scholarly journals Oral direct-acting antivirals and the incidence or recurrence of hepatocellular carcinoma: a systematic review and meta-analysis

2018 ◽  
Vol 9 (4) ◽  
pp. 262-270 ◽  
Author(s):  
Sonal Singh ◽  
Amit Nautiyal ◽  
Yoon K Loke
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Observational Studies ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Random Effects Model ◽  
Direct Acting Antivirals ◽  
Direct Acting Antiviral ◽  
Direct Acting

BackgroundThe influence of direct-acting antiviral (DAA) therapy for chronic hepatitis C virus on the risk of hepatocellular carcinoma (HCC) is conflicting.MethodsWe conducted a systematic review and meta-analysis to determine the incidence or recurrence of HCC associated with oral DAA therapy. We searched PubMed, Scopus, Embase from inception to August 2017 to identify observational studies reporting on HCC among patients treated with DAAs. Two independent reviewers extracted data and assessed the risk of bias. Data were pooled by random-effects model. The primary outcome was the proportion of participants with incidence or recurrence of HCC (PROSPERO number CRD42017057040).ResultsAfter reviewing 2080 citations, we included 8 controlled studies and 36 uncontrolled studies. The pooled proportion for incident HCC was 1.5 % (95% CI 1.0% to 2.1%; I2=90.1%; n= 542/39 145) from 18 uncontrolled studies and 3.3% (95% CI 1.2% to 9%; I2 =96%; n=109/6909) from 5 controlled studies, respectively. The pooled proportion for recurrent HCC was 16.7% (95% CI 10.2% to 26%; I2=84.8%; n=136/867) from 12 uncontrolled studies and 20.1% (95% CI 5.5% to 52.1%; I2=87.5%; n=36/225) from 3 controlled studies, respectively. There was no statistically significant effect on the risk of recurrent HCC (OR 0.50, 95%CI 0.16 to 1.59; I2 =73.4%) in a meta-analysis of three studies.ConclusionsOur findings show low proportion of incident HCC, but high proportion of recurrent HCC on treatment with DAAs. Continued active surveillance for HCC after treatment with DAAs remains prudent.

scholarly journals Hepatocellular Carcinoma Recurrence after Hepatitis C Virus Therapy with Direct-Acting Antivirals. A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (8) ◽  
pp. 1694
Author(s):  
Leonardo Frazzoni ◽  
Usama Sikandar ◽  
Flavio Metelli ◽  
Sinan Sadalla ◽  
Giuseppe Mazzella ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Meta Analysis ◽  
Random Effect ◽  
Complete Response ◽  
Direct Acting Antivirals ◽  
Direct Acting ◽  
Hcc Recurrence

Background: Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality among patients with cirrhosis. The risk of HCC recurrence after a complete response among patients treated with direct-acting antivirals (DAAs) has not been fully elucidated yet. Aim: To assess the risk of HCC recurrence after DAA therapy for hepatitis C virus (HCV). Methods: A systematic review across PubMed, Scopus and Scholar up to November 2020, including full-text studies that assessed the pattern of HCC recurrence after DAA therapy for HCV. Random-effect meta-analysis and univariable metaregression were applied to obtain pooled estimates for proportions and relative risk (RR) and variables influential for the outcome, respectively. Results: Thirty-one studies with 2957 patients were included. Overall, 30% (CI, 26–34%) of the patients with a history of HCC experienced HCC recurrence after DAA therapy, at mean time intervals ranging from 4 to 21 months. This result increased when going from European studies (23%, CI, 17–28%) to US studies (34%, CI, 30–38%), to Egyptian studies (37%, CI, 27–47%), and to Asian studies (33%, CI, 27–40%). Sixty-eight percent (CI, 45–91%) of recurrent HCCs developed within 6 months of follow-up since DAA treatment, among the eight studies providing stratified data. Among the studies providing head-to-head comparisons, the HCC recurrence risk was significantly lower after DAA therapy than IFN (RR, 0.64; CI, 0.51–0.81), and after DAA therapy than no intervention (RR, 0.68; CI, 0.49–0.94). Conclusions: The recurrence of HCC after DAA is not negligible, being higher soon after the end of treatment and among non-European countries. DAA therapy seems to reduce the risk of HCC recurrence compared to an IFN regimen and no intervention.

scholarly journals Systematic review with meta-analysis: recurrence of hepatocellular carcinoma following direct-acting antiviral therapy

2018 ◽  
Vol 48 (2) ◽  
pp. 127-137 ◽  
Author(s):  
N. Saraiya ◽  
A. C. Yopp ◽  
N. E. Rich ◽  
M. Odewole ◽  
N. D. Parikh ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Antiviral Therapy ◽  
Meta Analysis ◽  
Direct Acting Antiviral ◽  
Direct Acting

scholarly journals Asociación entre la exposición al frío y el asma: revisión sistemática y meta-análisis, 1965-2015

2021 ◽  
Vol 36 (1) ◽  
pp. 158-177
Author(s):  
Germán Zuluaga Ramírez ◽  
Iván Sarmiento Combariza ◽  
Juan Pimentel González ◽  
Neil Andersson
Keyword(s):  
Systematic Review ◽  
Cold Exposure ◽  
Observational Studies ◽  
Respiratory Diseases ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Risk Of Bias ◽  
Random Effects Model ◽  
Revisión Sistemática ◽  
Environmental Air

Objectives: to conduct a systematic review and a meta-analysis of observational and expe- rimental studies that explore the relation between asthma and cold exposure. Materials and methods: systematic review of experimental and observational studies pu- blished up to August 2015 in Pubmed, Embase and Lilacs. Two researchers selected studies that measured the occurrence of asthma in individuals exposed to different environmen- tal temperatures. A meta-analysis used RevMan 5.3’s random effects model to calculate a summary weighted Odds Ratio with 95% confidence intervals, and a sensitivity analysis identified the influence of each study. Subsequent subgroup analyses identified summary measures by type of cold exposure and study design. Additional analysis measured hetero- geneity and risk of bias. Results: we found 86 studies measuring the relation between cold exposure and asthma. We included 11.6% (10/86) of the studies in the meta-analysis and found an association between cold exposure and asthma with all the studies (ORw 2.0 95%CI 1.28-3.14), with the subgroup of experimental studies (ORw 3.8 IC95% 1.70-8.86), and with cold environmental air (ORw 1.59 IC95% 1.10-2.30). The studies had high risk of bias and statistical heteroge- neity [I2 : 63.1% (27%-81.4%)]. Conclusions: the results support the hypothesis of an association between asthma and cold exposure. This study encourages to explore the concepts proposed by traditional medi- cine to establish its benefits on prevention and care of respiratory diseases, such as asthma.

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