Metformin reduces hepatocellular carcinoma incidence after successful antiviral therapy in patients with diabetes and chronic hepatitis C in Taiwan
Abstract
BACKGROUND & AIMS
Diabetes mellitus (DM) has increased the risk of hepatocellular carcinoma (HCC) among chronic hepatitis C (CHC) patients. We aimed to evaluate whether metformin reduces HCC risk among diabetic CHC patients after successful antiviral therapy.
METHODS
CHC patients who achieved a sustained virological response (SVR) after interferon-based therapy were enrolled in a large-scale, multicenter cohort in Taiwan (T-COACH). HCC one-year after SVR were identified by linking to the catastrophic illness and cancer registry databases.
RESULTS
Of 7,249 CHC patients enrolled in the study, 781 (10.8%) patients had diabetes with 647 (82.8%) metformin users. During a median follow-up of 4.4 years, 227 patients developed new-onset HCC. The 5-year cumulative HCC incidence were 10.9% in DM non-metformin users and 2.6% in DM metformin users, compared to 3.0% in non-DM patients (adjusted hazard ratio [aHR], 95% confidence interval [95% CI]: 2.83, 1.57-5.08 and 1.46, 0.98-2.19, respectively). Cirrhosis was the most important factors significantly associated with higher HCC risk in Cox regression analysis, followed by DM non-metformin use, older age, male, and obesity; whereas hyperlipidemia with statin use was associated with a lower HCC risk. Risk stratification with the two most crucial risk factors, LC and DM non-metformin use, found significant effects of the two risks in predicting HCC risk among CHC patients after SVR. The benefits of metformin use were consistently observed…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 7,249 participants or records.
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