Long‐term use of oral nucleos(t)ide analogues for chronic hepatitis B does not increase cancer risk – a cohort study of 44 494 subjects

Summary Background Patients with chronic hepatitis B (CHB) need long‐term antiviral treatment with nucleos(t)ide analogues (NA). Animal studies suggest that some NA may increase cancer risk, but human data are lacking. Aim To investigate cancer risks in patients with or without NA treatment. Methods...

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Bibliographic Details
Published in:Alimentary pharmacology & therapeutics 2017-05, Vol.45 (9), p.1213-1224
Main Authors: Wong, G. L.‐H., Tse, Y.‐K., Yip, T. C.‐F., Chan, H. L.‐Y., Tsoi, K. K.‐F., Wong, V. W.‐S.
Format: Article
Language:English
Subjects:
Administration, Oral
Adult
Antiviral agents
Antiviral Agents - therapeutic use
Cancer
Classification
Cohort analysis
Cohort Studies
Female
Health risk assessment
Health risks
Hepatitis
Hepatitis B
Hepatitis B, Chronic - drug therapy
Hepatocellular carcinoma
Hong Kong - epidemiology
Humans
Interferon
Kidneys
Liver
Lungs
Male
Middle Aged
Neoplasms - epidemiology
Propensity Score
Proportional Hazards Models
Risk
Territory
Young Adult
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Summary:Summary Background Patients with chronic hepatitis B (CHB) need long‐term antiviral treatment with nucleos(t)ide analogues (NA). Animal studies suggest that some NA may increase cancer risk, but human data are lacking. Aim To investigate cancer risks in patients with or without NA treatment. Methods We conducted a territory‐wide cohort study using the database from Hospital Authority in Hong Kong. The diagnosis of CHB and various malignancies was based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) diagnosis codes between 2000 and 2012. Patients exposed to any of the oral NA for CHB were included. The primary outcome was incident cancers. A 3‐year landmark analysis, with follow‐up up to 7 years, was used to evaluate the relative risk of cancers in treated and untreated patients. Results A total of 44 494 patients (39 712 untreated and 4782 treated) were included in the analysis. During 194 890 patient‐years of follow‐up, hepatocellular carcinoma developed in 402 (1.0%) untreated patients and 179 (3.7%) treated patients, while other cancers developed in 528 (1.3%) and 128 (2.7%) patients respectively. After propensity score weighting, treated patients had similar risks of all malignancies [weighted hazard ratio (wHR): 1.01, 95% CI: 0.82–1.25, P = 0.899], lung/pleural cancers (wHR: 0.82, 95% CI: 0.52–1.31, P = 0.409) and urinary/renal malignancies (wHR: 1.04, 95% CI: 0.38–2.81, P = 0.944) when compared with untreated patients. Conclusions Oral nucleos(t)ide analogue treatment does not appear to increase cancer risk in patients with chronic hepatitis B. Given the beneficial effect on liver outcomes, our data support the current practice of long‐term anti‐viral therapy.
ISSN:0269-2813
1365-2036
DOI:10.1111/apt.14015