亲脂性他汀类药物可减少肝细胞癌和慢性肝炎死亡

StephenW

Lipophilic Statins Decrease Hepatocellular Carcinoma and Death in Chronic Hepatitis
Virginia A. Schad, PharmD, RPh

Lipophilic statins may be associated with significantly reducing the incidence of hepatocellular carcinoma (HCC) and mortality, according to study results published in the Annals of Internal Medicine.

Approximately 500,000 cases of HCC are diagnosed worldwide each year, and data suggest that in chronic liver disease 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) may improve clinical outcomes and reduce HCC risk.  However, the influence of different statin classes on HCC risk and survival is unknown. Therefore, researchers assessed the relationship between lipophilic or hydrophilic statin use and HCC incidence and mortality in a nationwide population with viral hepatitis in Sweden.


Patients included a propensity score-matched cohort of 16,668 adults (8334 who initiated statin use [6554 lipophilic and 1780 hydrophilic] and 8334 nonusers) among 63,279 eligible adults (15,104 with hepatitis B virus infection and 48,175 with hepatitis C virus infection). Compared with nonusers, the 10-year HCC risk was significantly lower in lipophilic statin users (8.1% vs 3.3%) but not hydrophilic statin users (8.0% vs 6.8%). However, the inverse association between lipophilic statins and HCC risk seemed to be dose-dependent as the 10-year HCC risk was lowest with 600 or more lipophilic statin cumulative defined daily doses compared with nonusers (2.5% vs 8.4%). In addition, 10-year mortality was significantly lower in both lipophilic (7.3% vs 15.2%) and hydrophilic (11.5% vs 16.0%) statin users compared with nonusers.

The researchers concluded, “In a nationwide viral hepatitis cohort, lipophilic statins were associated with significantly reduced HCC incidence and mortality.” They added, “Further research is needed to determine whether lipophilic statin therapy is feasible for prevention of HCC.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Simon TG, Duberg A-S, Aleman S, et al. Lipophilic statins and risk for hepatocellular carcinoma and death in patients with chronic viral hepatitis: results from a nationwide Swedish population. Ann Intern Med 2019;171:318-327.

StephenW

亲脂性他汀类药物可减少肝细胞癌和慢性肝炎死亡
弗吉尼亚·夏德（Virginia A.

根据发表在《内科学年鉴》上的研究结果，亲脂性他汀类药物可能与显着降低肝细胞癌（HCC）的发生率和死亡率有关。

全世界每年大约诊断出500,000例HCC病例，数据表明，在慢性肝病中，3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）可以改善临床结果并降低HCC风险。但是，尚不清楚不同他汀类药物对肝癌风险和生存的影响。因此，研究人员评估了瑞典全国性病毒性肝炎人群中亲脂性或亲水性他汀类药物的使用与HCC发生率和死亡率之间的关系。


患者包括63,279名合格成年人（15,104名乙肝病毒感染者和48,175名乙肝病毒感染者）中的16,668名成年人（开始使用他汀类药物[6554亲脂性和1780亲水性]和8334名非使用者）的倾向得分匹配队列。与非使用者相比，亲脂性他汀类药物使用者的10年HCC风险显着降低（8.1％比3.3％），但亲水性他汀类药物使用者却不低（8.0％对6.8％）。然而，亲脂性他汀类药物与HCC风险之间的负相关性似乎是剂量依赖性的，因为600或更多的亲脂性他汀类药物累积定义日剂量与非使用者相比，十年期HCC风险最低（2.5％比8.4％）。此外，与非使用者相比，亲脂性他汀类药物使用者的10年死亡率显着降低（分别为7.3％和15.2％）和亲水性（11.5％和16.0％）。

研究人员总结说：“在全国范围内的病毒性肝炎队列研究中，亲脂性他汀类药物显着降低了HCC的发生率和死亡率。”他们补充说，“需要进一步的研究以确定亲脂性他汀类药物疗法是否可预防HCC。”

披露：一些研究作者宣布与制药行业有从属关系。请参阅原始参考资料，以获得作者披露的完整列表。

参考

Simon TG，Duberg A-S，Aleman S等。亲脂性他汀类药物与慢性病毒性肝炎患者发生肝细胞癌和死亡的风险：来自瑞典全国的结果。 Ann Intern Med 2019; 171：318-327。