NEW YORK (Reuters Health) – New research provides supporting evidence for chemopreventive effects of statins on hepatocellular carcinoma (HCC) in patients with nonalcoholic steatohepatitis (NASH) cirrhosis.
In the American Journal of Gastroenterology, Dr. Kanokwan Pinyopornpanish with Cleveland Clinic Foundation, in Ohio, and colleagues report results of a retrospective study of 1,072 patients with NASH-related advanced liver fibrosis, including 22 with bridging fibrosis (F3) and 950 with cirrhosis (F4), who were followed for about 14 years.
The researchers report three major findings from this “well-characterized” cohort of patients with NASH and advanced fibrosis.
First, patients with NASH and stage-3 fibrosis have a low risk of HCC; no patient with F3 developed HCC during 602 person-year follow-up, they report.
Second, despite the high risk of HCC in patients with NASH cirrhosis, the development of HCC varied significantly among subgroups of patients.
Among patients with cirrhosis, HCC developed in 82 patients with the annual incidence rate of 1.90 per 100 person-years. Multivariable analysis revealed that HCC was associated with male sex, older age and Child-Turcotte-Pugh (CTP) score B and C (versus A).
Third, patients with NASH cirrhosis who were treated with a statin had a significantly lower risk of developing HCC compared with nonstatin users (hazard ratio, 0.40; 95% confidence interval, 0.24 to 0.67) and the effect was dose-dependent.
“Each 365 increment in cumulative defined daily dose of statin use reduced HCC risk by 23.6%,” the study team reports.
“Our data also suggest an association between lipophilic statin use and less HCC occurrence. Although there was a beneficial trend among hydrophilic statin users, the effect did not reach statistical significance,” they note.
Due to the limited number of patients with CTP B and C in the cohort, “caution and careful consideration should be taken before initiating statin in this group, and we recommend weighing the risks and benefits for each individual patient,” they advise.
“Generally, statins have been shown to be well tolerated without increasing incidence of hepatotoxicity among patients with chronic liver disease, including patients without cirrhosis, compensated cirrhosis, and decompensated cirrhosis,” they add.
The study had no commercial support and the authors have no relevant disclosures.
SOURCE: https://bit.ly/36xWbuv American Journal of Gastroenterology, online July 2, 2021.
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