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Letter to the Editor| Volume 68, ISSUE 3, P616-617, March 2018

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Reply to: “Direct antiviral agents and risk of HCC: Waiting for Godot”

Published:October 09, 2017DOI:https://doi.org/10.1016/j.jhep.2017.10.002
Reply to: “Direct antiviral agents and risk of HCC: Waiting for Godot”
Previous ArticleDirect antiviral agents and risk of HCC: Waiting for Godot
Next ArticleAcid-base disorders in liver disease
      We appreciate the correspondence of Cammà and Leandro on our study “Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: A systematic review, meta-analyses, and meta-regression”.
      • Waziry R.
      • Hajarizadeh B.
      • Grebely J.
      • Amin J.
      • Law M.
      • Danta M.
      • et al.
      Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: A systematic review, meta-analyses, and meta-regression.
      J Hepatol. 2017; 67: 1204-1212
      They make several important points in relation to the limitations of systematic reviews in general and our specific evaluation of hepatocellular carcinoma (HCC) risk following interferon-based and direct-acting antiviral (DAA) therapy cure. In the absence of large randomized controlled clinical trials, a comprehensive systematic review and meta-analysis of cohort-based outcomes serves as the only available assessment of existing evidence. As such, a critical investigation of the overt sources of bias and disparity in the individual studies, as outlined by Cammà and Leandro, is a key component of conducting a systematic review and meta-analysis.
      • Moher D.
      • Olkin I.
      Meta-analysis of randomized controlled trials. A concern for standards.
      JAMA. 1995; 274: 1962-1964
      , 
      • LeLorier J.
      • Gregoire G.
      • Benhaddad A.
      • Lapierre J.
      • Derderian F.
      Discrepancies between meta-analyses and subsequent large randomized, controlled trials.
      N Engl J Med. 1997; 337: 536-542
      , 
      • Villar J.
      • Carroli G.
      • Belizan J.M.
      Predictive ability of meta-analyses of randomised controlled trials.
      Lancet. 1995; 345: 772-776
      , 
      • Thompson S.G.
      Why sources of heterogeneity in meta-analysis should be investigated.
      BMJ. 1994; 309: 1351-1355
      , 
      • Lau J.
      • Ioannidis J.P.
      • Schmid C.H.
      Summing up evidence. One answer is not always enough.
      Lancet. 1998; 351: 123-127

      Linked Article

      • Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: A systematic review, meta-analyses, and meta-regression
        Journal of HepatologyVol. 67Issue 6
        • Preview
          Primary liver cancer is the fifth most common cancer in men, and the ninth in women.1 The alarmingly poor prognosis enhances the burden of primary liver cancer; the third leading cause of cancer mortality in 2013.2 In high-income countries, an increasing proportion of the most common type of primary liver cancer, hepatocellular carcinoma (HCC), is attributed to hepatitis C virus (HCV) infection.3,4 Opportunities to increase the uptake of direct-acting antiviral (DAA) therapy are among the most promising strategies for reducing the future burden of HCC.
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      • Direct antiviral agents and risk of HCC: Waiting for Godot
        Journal of HepatologyVol. 68Issue 3
        • Preview
          Dr Waziry et al. report a meta-analysis1 of aggregate data from randomized and non-randomized (prospective and retrospective) studies of patients with HCV-related cirrhosis, comparing the risk of HCC occurrence or recurrence after sustained virological response (SVR) following direct-acting antivirals (DAAs) vs. interferon (IFN)-based treatments. The authors concluded that there is no evidence for differential HCC occurrence or recurrence following SVR from DAAs and IFN-based therapy. We have some methodological questions about this analysis and the interpretation of results.
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      References

        • Waziry R.
        • Hajarizadeh B.
        • Grebely J.
        • Amin J.
        • Law M.
        • Danta M.
        • et al.
        Hepatocellular carcinoma risk following direct-acting antiviral HCV therapy: A systematic review, meta-analyses, and meta-regression.
        J Hepatol. 2017; 67: 1204-1212
        View in Article
        • Moher D.
        • Olkin I.
        Meta-analysis of randomized controlled trials. A concern for standards.
        JAMA. 1995; 274: 1962-1964
        View in Article
        • LeLorier J.
        • Gregoire G.
        • Benhaddad A.
        • Lapierre J.
        • Derderian F.
        Discrepancies between meta-analyses and subsequent large randomized, controlled trials.
        N Engl J Med. 1997; 337: 536-542
        View in Article
        • Villar J.
        • Carroli G.
        • Belizan J.M.
        Predictive ability of meta-analyses of randomised controlled trials.
        Lancet. 1995; 345: 772-776
        View in Article
        • Thompson S.G.
        Why sources of heterogeneity in meta-analysis should be investigated.
        BMJ. 1994; 309: 1351-1355
        View in Article
        • Lau J.
        • Ioannidis J.P.
        • Schmid C.H.
        Summing up evidence. One answer is not always enough.
        Lancet. 1998; 351: 123-127
        View in Article
        • Bailar 3rd., J.C.
        The promise and problems of meta-analysis.
        N Engl J Med. 1997; 337: 559-561
        View in Article
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        • Lau J.
        Issues in comparisons between meta-analyses and large trials.
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        J Hepatol. 2017; 67: 65-71
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        Damned to fame: the life of Samuel Beckett.
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      Article info

      Publication history

      Published online: October 09, 2017

      Identification

      DOI: https://doi.org/10.1016/j.jhep.2017.10.002

      Copyright

      © 2017 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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