Sustained virologic response and other potential genotype-specific roles of statins among patients with hepatitis C-related chronic liver diseases

The benefit of statins in chronic hepatitis C patients: a systematic review and meta-analysis

BACKGROUND AND AIM

Besides regulating lipid metabolism, statins have garnered considerable interest because of their antiviral and antineoplastic properties. The potential benefit of statins using in chronic hepatitis C (CHC) patients is not well described. This meta-analysis was carried out to quantitatively assess the efficacy of statins in improving the therapeutic effect and prognosis of patients with CHC.

PATIENTS AND METHODS

We searched electronic databases for relevant studies comparing the course of benefit in CHC patients with statins versus without statins. Risk estimates were pooled to assess the association of statins use with sustained virological response and the prognosis of CHC patients.

RESULTS

Twenty-three studies fulfilled the inclusion criteria. Meta-analysis of 16 homogeneous studies showed that the sustained virological response rate increased by 31% [relative risk (RR)=1.31; 95% confidence interval (CI): 1.23-1.39] in 12 791 CHC patients with statins as an adjuvant under the general antiviral therapy compared with those without this adjuvant therapy. Moreover, meta-analysis of seven studies suggested that statins was beneficial on several specific poor outcomes of CHC patients (RR=0.49; 95% CI: 0.42-0.56). CHC patients with statin use were found to be inversely associated with a 55% reduced risk of hepatocellular carcinoma (RR=0.45; 95% CI: 0.36-0.57) and 53% reduced risk of cirrhosis (RR=0.47; 95% CI: 0.33-0.67) as well as 44% reduced risk of mortality (RR=0.56; 95% CI: 0.46-0.69). However, significant heterogeneity and publication bias were present in some of our analyses.

CONCLUSION

Beneficial effects of statins use were found in the therapy and the prognosis of CHC patients. Further prospective studies are still needed to confirm these benefits.

Efficacy of addition of statins to interferon α and ribavirin for hepatitis C: A meta-analysis

AIM

To systematically evaluate the therapeutic efficacy of statins as add-on to interferon α (IFNα) plus ribavirin (RBV) therapy for hepatitis C.

METHODS

A thorough search was done in PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, Wanfang Data, SinoMed and VIP to collect articles on statins as add-on to IFNα plus RBV therapy for hepatitis C. Quality of each study was assessed, and meta-analysis of sustained virological response (SVR), rapid virological response (RVR) and early virological response (EVR) was performed with RevMan5.3 software.

RESULTS

Seven randomized controlled trials were included with 202 patients in the add-on therapy group and 198 patients in the control group. Meta-analysis showed that triple therapy with IFNα, RBV and statin was superior to therapy with IFNα and RBV in achieving SVR and RVR (OR = 2.18, 95%CI: 1.42-3.34, P = 0.0004; OR = 2.37, 95%CI: 1.11-5.09, P = 0.03), while the difference in EVR was not significant (OR = 1.42, 95%CI: 0.86-2.36, P = 0.17). For hepatitis C virus genotype 1, the increase in the SVR rate remained significant (OR = 2.41, 95%CI: 1.33-4.36, P = 0.004).

CONCLUSION

The addition of statins to IFNα and RBV can improve sustained virological response and increase the cure rate in hepatitis C.

Statins and its hepatic effects: Newer data, implications, and changing recommendations

Hepatic adverse effects are one of the most commonly known adverse effects reported with statins. Frequently, fear of serious hepatic effects contributes to underutilization of statins as well as unnecessary discontinuation of its use among those indicated. There are changing data on the occurrence of these negative hepatic effects, recommendations on their actual risk, monitoring required, and safety of use in those with preexisting hepatic disorders. Based on reviewed literature, statins appear to be associated with a very low risk of true and serious liver injury. Unprecedented fears regarding hepatic adverse effects of statins among prescribers and patients can deny patients of the significant benefits of these agents. Routine periodic monitoring of liver function does not appear to detect or prevent serious liver injury and hence may not be indicated. But the potential of statins to cause significant and serious hepatic effects should not be overlooked in daily clinical practice. Statin use need not be avoided in patients with preexisting liver dysfunction such as nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, compensated cirrhosis, and compensated chronic liver disease if its use is clearly indicated. Physician's judgment based on the risk and benefit for an individual patient does matter when a strategy is chosen regarding the use of statins and monitoring patients while on statins.

Hepatitis C virus infection: Are there still specific problems with genotype 3?

Hepatitis C virus (HCV) infection is one of the most common causes of chronic liver disease and the main indication for liver transplantation worldwide. As promising specific treatments have been introduced for genotype 1, clinicians and researchers are now focusing on patients infected by non-genotype 1 HCV, particularly genotype 3. Indeed, in the golden era of direct-acting antiviral drugs, genotype 3 infections are no longer considered as easy to treat and are associated with higher risk of developing severe liver injuries, such as cirrhosis and hepatocellular carcinoma. Moreover, HCV genotype 3 accounts for 40% of all HCV infections in Asia and is the most frequent genotype among HCV-positive injecting drug users in several countries. Here, we review recent data on HCV genotype 3 infection/treatment, including clinical aspects and the underlying genotype-specific molecular mechanisms.