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Duberg, Ann-Sofi, DocentORCID iD iconorcid.org/0000-0001-7248-0910
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Publications (10 of 57) Show all publications
Simon, T. G., Duberg, A.-S., Aleman, S., Chung, R. T., Chan, A. T. & Ludvigsson, J. F. (2020). Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality. New England Journal of Medicine, 382(11), 1018-1028
Open this publication in new window or tab >>Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality
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2020 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 382, no 11, p. 1018-1028Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: More information is needed about the long-term effects of low-dose aspirin (≤160 mg) on incident hepatocellular carcinoma, liver-related mortality, and gastrointestinal bleeding in persons with chronic hepatitis B or hepatitis C virus infection.

METHODS: Using nationwide Swedish registries, we identified all adults who received a diagnosis of chronic hepatitis B or hepatitis C from 2005 through 2015 and who did not have a history of aspirin use (50,275 patients). Patients who were starting to take low-dose aspirin (14,205 patients) were identified by their first filled prescriptions for 90 or more consecutive doses of aspirin. We constructed a propensity score and applied inverse probability of treatment weighting to balance baseline characteristics between groups. Using Cox proportional-hazards regression modeling, we estimated the risk of hepatocellular carcinoma and liver-related mortality, accounting for competing events.

RESULTS: With a median of 7.9 years of follow-up, the estimated cumulative incidence of hepatocellular carcinoma was 4.0% among aspirin users and 8.3% among nonusers of aspirin (difference, -4.3 percentage points; 95% confidence interval [CI], -5.0 to -3.6; adjusted hazard ratio, 0.69; 95% CI, 0.62 to 0.76). This inverse association appeared to be duration-dependent; as compared with short-term use (3 months to <1 year), the adjusted hazard ratios were 0.90 (95% CI, 0.76 to 1.06) for 1 to less than 3 years of use, 0.66 (95% CI, 0.56 to 0.78) for 3 to less than 5 years of use, and 0.57 (95% CI, 0.42 to 0.70) for 5 or more years of use. Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among nonusers (difference, -6.9 percentage points [95% CI, -8.1 to -5.7]; adjusted hazard ratio, 0.73 [95% CI, 0.67 to 0.81]). However, the 10-year risk of gastrointestinal bleeding did not differ significantly between users and nonusers of aspirin (7.8% and 6.9%, respectively; difference, 0.9 percentage points; 95% CI, -0.6 to 2.4).

CONCLUSIONS: In a nationwide study of patients with chronic viral hepatitis in Sweden, use of low-dose aspirin was associated with a significantly lower risk of hepatocellular carcinoma and lower liver-related mortality than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding. (Funded by the National Institutes of Health and others.).

Place, publisher, year, edition, pages
Massachussetts Medical Society, 2020
National Category
Medical and Health Sciences Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-81583 (URN)10.1056/NEJMoa1912035 (DOI)32160663 (PubMedID)2-s2.0-85081675148 (Scopus ID)
Available from: 2020-05-06 Created: 2020-05-06 Last updated: 2020-05-06Bibliographically approved
Udumyan, R., Montgomery, S., Duberg, A.-S., Fang, F., Valdimarsdottir, U., Ekbom, A., . . . Fall, K. (2020). Beta-adrenergic receptor blockers and liver cancer mortality in a national cohort of hepatocellular carcinoma patients. Scandinavian Journal of Gastroenterology
Open this publication in new window or tab >>Beta-adrenergic receptor blockers and liver cancer mortality in a national cohort of hepatocellular carcinoma patients
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2020 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: β-adrenergic signaling has been implicated in the pathology of hepatocellular carcinoma (HCC), but the evidence from clinical studies is limited. In this national population-based cohort study, we investigated the possible association of β-adrenergic receptor blockers and cancer-specific mortality among patients with primary HCC diagnosed in Sweden between 2006 and 2014.

Methods: Patients were identified from the Swedish Cancer Register (n = 2104) and followed until 31 December 2015. We used Cox regression to evaluate the association of β-blockers dispensed within 90 days prior to cancer diagnosis, ascertained from the national Prescribed Drug Register, with liver cancer mortality identified from the Cause of Death Register, while controlling for socio-demographic factors, tumor characteristics, comorbidity, other medications and treatment procedures.

Results: Over a median follow-up of 9.9 months, 1601 patients died (of whom 1309 from liver cancer). Compared with non-use, β-blocker use at cancer diagnosis [n = 714 (predominantly prevalent use, 93%)] was associated with lower liver cancer mortality [0.82 (0.72-0.94); p = .005]. Statistically significant associations were observed for non-selective [0.71 (0.55-0.91); p = .006], β1-receptor selective [0.86 [0.75-1.00); p = .049] and lipophilic [0.78 (0.67-0.90); p = .001] β-blockers. No association was observed for hydrophilic β-blockers [1.01 (0.80-1.28); p = .906] or other antihypertensive medications. Further analysis suggested that the observed lower liver cancer mortality rate was limited to patients with localized disease at diagnosis [0.82 (0.67-1.01); p = .062].

Conclusion: β-blocker use was associated with lower liver cancer mortality rate in this national cohort of patients with HCC. A higher-magnitude inverse association was observed in relation to non-selective β-blocker use.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Register-based cohort study, beta-adrenergic signaling, non-selective beta-blockers, selective beta-blockers, survival analysis
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-81928 (URN)10.1080/00365521.2020.1762919 (DOI)32412855 (PubMedID)
Available from: 2020-05-19 Created: 2020-05-19 Last updated: 2020-05-19Bibliographically approved
Aleman, S., Söderholm, J., Büsch, K., Kövamees, J. & Duberg, A.-S. (2020). Frequent loss to follow-up after diagnosis of hepatitis C virus infection: A barrier toward the elimination of hepatitis C virus. Liver international (Print)
Open this publication in new window or tab >>Frequent loss to follow-up after diagnosis of hepatitis C virus infection: A barrier toward the elimination of hepatitis C virus
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2020 (English)In: Liver international (Print), ISSN 1478-3223, E-ISSN 1478-3231Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Previous studies on hepatitis C cascade of care have been mainly focused on diagnosis and treatment rate, while less attention has been given to patients lost to follow-up (LTFU) after diagnosis. Analyses of this latter issue on population level are missing.

AIMS: In this nationwide study of people with HCV, we aimed to estimate the proportion LTFU after HCV diagnosis, characterize them, and analyze their other healthcare contacts.

METHODS: Patients diagnosed with chronic HCV in the Swedish National Patient register during 2001-2011 and still alive December 31, 2013, were included. The number of cured patients without need of follow-up was estimated. Visits to HCV specialist care during 2012-2013 were analysed. For those LTFU, other specialist care contacts were studied.

RESULTS: In total 29,217 patients were included, with 24,733 with need of HCV care. 61% (n=15,007) of them were LTFU from HCV care in 2012-2013 and 58% did not attend HCV care during the second year after HCV diagnosis. The departments of surgery/orthopedic or psychiatry/dependency were the most common other non-primary healthcare contacts. Predictors for LTFU were young age, male sex, low education, presence of psychiatric/dependency diagnosis, unmarried, and longer duration since diagnosis of HCV.

CONCLUSIONS: This study showed that almost two-thirds of patients were LTFU after HCV diagnosis, with frequent occurrence early after diagnosis. Efforts to link patients back to HCV care, in combination with early and easy access to HCV treatment and harm reduction, are necessary to reach the HCV elimination goal.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2020
Keywords
HCV, cascade, healthcare contacts, lost to follow-up
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-81347 (URN)10.1111/liv.14469 (DOI)32294288 (PubMedID)
Available from: 2020-04-29 Created: 2020-04-29 Last updated: 2020-04-29Bibliographically approved
Batyrbekova, N., Aleman, S., Lybeck, C., Montgomery, S. & Duberg, A.-S. (2020). Hepatitis C virus infection and the temporal trends in the risk of liver cancer: a national register-based cohort study in Sweden. Cancer Epidemiology, Biomarkers and Prevention, 29(1), 63-70
Open this publication in new window or tab >>Hepatitis C virus infection and the temporal trends in the risk of liver cancer: a national register-based cohort study in Sweden
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2020 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 29, no 1, p. 63-70Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In many countries, including Sweden, the birth cohorts with the highest prevalence of hepatitis C virus (HCV) infection have now reached the ages with high risk of primary liver cancer (PLC). The aims were to investigate the temporal trends in PLC incidence and the relative risks of PLC among people diagnosed with HCV-infection between 1990 and 2015.

METHODS: The HCV-cohort (n: 52,853) was compared with a matched non-HCV comparison-cohort (n: 523,649). Both the Cancer (CR) and Death registers (DR) were used for follow-up. The crude and age-standardised PLC incidence rates were calculated. The relative risk was estimated as standardized incidence ratios (SIR) and as hazard ratios (HR) using stratified Cox hazards regression.

RESULTS: There were 1,609 with PLC-diagnosis in the HCV-cohort, the annual number increased continuously with the crude incidence rate reaching 4.56 per 1,000 person-years in 2013, while remaining low and stable in the comparison-cohort. In the HCV-cohort, the age-standardised PLC incidence rates per 1,000 person-years remained relatively constant at 2.64 (95% CI: 1.54, 3.75) in 2000 and 3.31 (2.51, 4.12) in 2014. The highest SIR was 73 (65.9, 79.5) among those infected for 35-40 years; and the highest HR was 65.9 (55.9, 77.6) for men and 62.2 (31.9, 121.1) for women.

CONCLUSIONS: There was a considerable increase in PLC-incidence over time and an extremely high relative risk in the population with HCV-infection for more than 35 years.

IMPACT: The national HCV-associated PLC-incidence should be monitored in future studies to evaluate the effect of DAA-treatment.

Place, publisher, year, edition, pages
American Association for Cancer Research, 2020
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:oru:diva-77946 (URN)10.1158/1055-9965.EPI-19-0769 (DOI)000521285100008 ()31719064 (PubMedID)2-s2.0-85077926564 (Scopus ID)
Note

Funding Agencies:

Research ALF grants from Region Örebro County  OLL-683801

Nyckelfonden, Örebro, Sweden  OLL-691511

Available from: 2019-11-20 Created: 2019-11-20 Last updated: 2020-04-07Bibliographically approved
Kåberg, M., Larsson, S. B., Jerkeman, A., Nystedt, A., Duberg, A.-S., Kövamees, J., . . . Söderholm, J. (2020). High risk of non-alcoholic liver disease mortality in patients with chronic hepatitis C with illicit substance use disorder. Scandinavian Journal of Gastroenterology, 1-7
Open this publication in new window or tab >>High risk of non-alcoholic liver disease mortality in patients with chronic hepatitis C with illicit substance use disorder
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2020 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, p. 1-7Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: Hepatitis C virus (HCV) is a slowly progressive disease, often transmitted among people who inject drugs (PWID). Mortality in PWID is high, with an overrepresentation of drug-related causes. This study investigated the risk of death in patients with chronic hepatitis C virus (HCV) infection with or without illicit substance use disorder (ISUD).Methods: Patients with HCV were identified using the Swedish National Patient Registry according to the International Classification of Diseases-10 (ICD-10) code B18.2, with ≤5 matched comparators from the general population. Patients with ≥2 physician visits with ICD-10 codes F11, F12, F14, F15, F16, or F19 were considered to have ISUD. The underlying cause of death was analyzed for alcoholic liver disease, non-alcoholic liver disease, liver cancer, drug-related and external causes, non-liver cancers, or other causes. Mortality risks were assessed using the standardized mortality ratio (SMR) with 95% CIs and Cox regression analyses for cause-specific hazard ratios.Results: In total, 38,186 patients with HCV were included, with 31% meeting the ISUD definition. Non-alcoholic liver disease SMRs in patients with and without ISUD were 123.2 (95% CI, 103.7-145.2) and 69.4 (95% CI, 63.8-75.3), respectively. The significant independent factors associated with non-alcoholic liver disease mortality were older age, being unmarried, male sex, and having ISUD.Conclusions: The relative risks for non-alcoholic liver disease mortality were elevated for patients with ISUD. Having ISUD was a significant independent factor for non-alcoholic liver disease. Thus, patients with HCV with ISUD should be given HCV treatment to reduce the risk for liver disease.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Hepatitis C, chronic, liver disease, mortality, substance abuse
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-81446 (URN)10.1080/00365521.2020.1754456 (DOI)32356496 (PubMedID)
Available from: 2020-05-05 Created: 2020-05-05 Last updated: 2020-05-05Bibliographically approved
Kamal, H., Westman, G., Falconer, K., Duberg, A.-S., Weiland, O., Haverinen, S., . . . Aleman, S. (2020). Long-term study of hepatitis D infection at secondary care centers: the impact of viremia on liver-related outcomes. Hepatology
Open this publication in new window or tab >>Long-term study of hepatitis D infection at secondary care centers: the impact of viremia on liver-related outcomes
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2020 (English)In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND & AIMS: Hepatitis delta virus (HDV) infection is associated with fast progression to liver cirrhosis and liver complications. Previous studies have though been mainly from tertiary care centers, with risk for referral bias towards patients with worse outcomes. Furthermore, the impact of HDV viremia per se on liver-related outcomes is not really known outside HIV co-infection setting. We have therefore evaluated the long-term impact of HDV viremia on liver-related outcomes in a nationwide cohort of hepatitis B and D co-infected patients, cared for at secondary care centers in Sweden.

APPROACH & RESULTS: In total 337 anti-HDV positive patients including 233 patients with HDV RNA viremia and 91 without HDV viremia at baseline were retrospectively studied, with a mean follow-up of 6.5 years (range 0.5-33.1). The long-term risks for liver-related events (i.e. hepatocellular carcinoma [HCC], hepatic decompensation, or liver-related death/transplantation) were assessed, using Cox regression analysis. The risk for liver-related events and HCC was 3.8 and 2.6 fold higher, respectively, in patients with HDV viremia compared to those without viremia, although the latter was not statistically significant. Among HDV viremic patients with no baseline cirrhosis, the cumulative risk of being free of liver cirrhosis or liver-related events was 81.9% and 64.0%, after 5 and 10 years of follow-up, respectively. This corresponds to an incidence rate of 0.04 per person-year.

CONCLUSION: HDV RNA viremia is associated with a 3.8 fold higher risk for liver-related outcomes. The prognosis was rather poor for non-cirrhotic patients with HDV viremia at baseline, but it was nevertheless more benign than previous estimates from tertiary centers. Our findings can be of importance when treatment decision making, and evaluating outcomes of upcoming new antivirals against HDV.

Place, publisher, year, edition, pages
Wiley-Interscience Publishers, 2020
Keywords
Cirrhosis, hepatitis delta virus, hepatocellular carcinoma, interferon, liver transplantation, mortality
National Category
Medical and Health Sciences Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-81582 (URN)10.1002/hep.31214 (DOI)32145073 (PubMedID)
Available from: 2020-05-06 Created: 2020-05-06 Last updated: 2020-05-06Bibliographically approved
Westin, J., Aleman, S., Castedal, M., Duberg, A.-S., Eilard, A., Fischler, B., . . . Wejstål, R. (2020). Management of hepatitis B virus infection, updated Swedish guidelines. Infectious Diseases, 52(1), 1-22
Open this publication in new window or tab >>Management of hepatitis B virus infection, updated Swedish guidelines
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2020 (English)In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 52, no 1, p. 1-22Article in journal (Refereed) Published
Abstract [en]

Despite access to effective antiviral drugs and vaccines, hepatitis B virus (HBV) infection remains a major health issue worldwide. HBV is highly infectious and may cause chronic infection, progressive liver damage, hepatocellular cancer (HCC) and death. Early diagnosis, proper management and timing of treatment are crucial. The Swedish Reference group for Antiviral Treatment (RAV) here provides updated evidence-based guidelines for treatment and management of HBV infection which may be applicable also in other countries. Tenofovir alafenamide (TAF) has been introduced as a novel treatment option and new principles regarding indication and duration of treatment and characterization of hepatitis B have been gradually introduced which justifies an update of the previous guidelines from 2007. Updated guidelines on HCC surveillance in HBV-infected patients, treatment and prophylaxis for patients undergoing liver transplantation as well as management of pregnant women and children with HBV infection are also provided.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Hepatitis B virus, antiviral treatment, chronic hepatitis, hepatocellular cancer, prophylaxis, surveillance
National Category
Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-77468 (URN)10.1080/23744235.2019.1675903 (DOI)000490733500001 ()31613181 (PubMedID)2-s2.0-85074330659 (Scopus ID)
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2020-02-19Bibliographically approved
Kjellin, M., Kileng, H., Akaberi, D., Palanisamy, N., Duberg, A.-S., Danielsson, A., . . . Lennerstrand, J. (2019). Effect of the baseline Y93H resistance-associated substitution in HCV genotype 3 for direct-acting antiviral treatment: real-life experience from a multicenter study in Sweden and Norway. Scandinavian Journal of Gastroenterology, 54(8), 1042-1050
Open this publication in new window or tab >>Effect of the baseline Y93H resistance-associated substitution in HCV genotype 3 for direct-acting antiviral treatment: real-life experience from a multicenter study in Sweden and Norway
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2019 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 54, no 8, p. 1042-1050Article in journal (Refereed) Published
Abstract [en]

Background: The NS5A resistance-associated substitution (RAS) Y93H is found quite frequently (5-10%) at baseline in direct-acting antiviral agents (DAA) treatment-naive genotype (GT) 3a patients when studied by the population-sequencing method (cut-off 20%). This RAS may impair HCV DAA treatment response, since it possesses a high fold in vitro resistance to daclatasvir (DCV) and velpatasvir (VEL) in GT 3. We investigated the effect of baseline Y93H in patients with GT 3a infection on treatment outcome, with or without resistance-based DAA-treatment during 2014-2017.

Patients/Methods: Treatment in the intervention group (n = 130) was tailored to baseline resistance-findings by population-sequencing method. Detection of baseline Y93H above 20% prompted a prolonged treatment duration of NS5A-inhibitor and sofosbuvir (SOF) and/or addition of ribavirin (RBV). Patients without baseline Y93H in the intervention group and all patients in the control group (n = 78) received recommended standard DAA-treatment.

Results: A higher sustained virologic response rate (SVR) in the intervention group was shown compared to the control group at 95.4% (124/130) and 88.5% (69/78), respectively (p = .06). All five patients with baseline Y93H in the intervention group achieved SVR with personalised treatment based on results from resistance testing; either with the addition of RBV or prolonged treatment duration (24w). In the control group, 2/4 patients with Y93H at baseline treated with ledipasvir/SOF/RBV or DCV/SOF without RBV, failed treatment.

Conclusion: The results from this real-life study are in accordance with the findings of the randomised controlled trials in 2015 and the EASL-guidelines of 2016, thus, baseline Y93H impacts on DCV and VEL treatment outcome.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Baseline resistance, NS5A, Y93H, hepatitis C virus, resistance-associated substitution, sustained virologic response
National Category
Infectious Medicine Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-75912 (URN)10.1080/00365521.2019.1652846 (DOI)000481902500001 ()31424972 (PubMedID)
Note

Funding Agencies:

Uppsala-Örebro Regional Research Council  RFR-651021  RFR-744511 

Erik, Karin and Gösta Selander Foundation  

Scandinavian Society for Antimicrobial Chemotherapy  SLS-692951 

Uppsala County Council  

Uppsala University 

Available from: 2019-08-26 Created: 2019-08-26 Last updated: 2019-11-22Bibliographically approved
Söderholm, J., Larsson, S. B., Jerkeman, A., Nystedt, A., Duberg, A.-S., Kövamees, J., . . . Kåberg, M. (2019). ELEVATED RISK FOR LIVER RELATED MORTALITY IN CHRONIC HEPATITIS C PATIENTS BOTH WITH OR WITHOUT ILLICIT SUBSTANCE USE DISORDER: A NATION-WIDE REGISTER STUDY. Paper presented at Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD) / Liver Meeting, Boston, MA, USA, November 8-12, 2019. Hepatology, 70(Suppl. 1), 366A-366A
Open this publication in new window or tab >>ELEVATED RISK FOR LIVER RELATED MORTALITY IN CHRONIC HEPATITIS C PATIENTS BOTH WITH OR WITHOUT ILLICIT SUBSTANCE USE DISORDER: A NATION-WIDE REGISTER STUDY
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2019 (English)In: Hepatology, ISSN 0270-9139, E-ISSN 1527-3350, Vol. 70, no Suppl. 1, p. 366A-366AArticle in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Hepatitis C is a slowly progressive disease mainly transmitted in people who inject drugs . This cohort has a high mortality from drug related causes, such as overdoses or external causes. We investigated the relative risk for liver related death in chronic hepatitis C (CHC) patients with or without illicit substance use disorders (SUD) .

Methods: Patients with CHC were identified using the Swedish National Patient Registry (contains all inpatient, day surgery, and outpatient non-primary care visits) according to the International Classification of Diseases-10 (ICD-10) code B18.2. The baseline observation was set to the first CHC visit from 2001, and person-time continued until death, emigration or December 31, 2013, whichever came first. Patients with ≥2 non-primary care visits with ICD-10 codes F11, F12, F14, F15, F16, or F19 were considered to have illicit SUD . The underlying cause of death was obtained from the Cause of Death Register . A six months lag-period between CHC diagnosis and death was introduced to reduce surveillance bias. Non-alcoholic liver disease was defined using ICD-10 codes K71–K77, B15–B19, B94.2, R17-R18, I85 .0, I98 .2, and I98 .3 . The relative risk for death was determined using standardized mortality ratio (SMR) where the observed number of deaths was divided by the expected number of deaths taken from five comparators from the general population (matched for age/sex/place of residency) .

Results: In total 38,186 patients with CHC were included in the study whereof 11,818 (31%) were considered to have illicit SUD . The CHC patients with SUD were younger (37 .7 vs . 46 .9 years) with a greater proportion of men (72% vs . 62%) than CHC patients without SUD . The SMRs for CHC patients with SUD were 10 .5, 33 .8, 18 .1, 123 .2, 61 .6, and 13 .2, for all-causes, liver cancer, alcoholic or non-alcoholic liver disease, drug-related, or external causes, respectively (Table 1) . The corresponding SMRs for CHC patients without SUD were 4 .1, 52 .8, 18 .0, 69 .4, 11 .2, and 4 .9, respectively (Table 1) .

Conclusion: The relative risks for all investigated parameters were elevated for CHC patients whether they had illicit SUD or not . Furthermore, although the CHC patients with SUD had a high relative risk to die from both drug-related and external causes, the relative risk to die from non-alcoholic liver disease was also greatly elevated .

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-77583 (URN)000488653501148 ()
Conference
Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD) / Liver Meeting, Boston, MA, USA, November 8-12, 2019
Available from: 2019-10-25 Created: 2019-10-25 Last updated: 2019-10-25Bibliographically approved
Simon, T. G., Duberg, A.-S., Aleman, S., Hagström, H., Nguyen, L. H., Khalili, H., . . . Ludvigsson, J. F. (2019). Lipophilic Statins and Risk for Hepatocellular Carcinoma and Death in Patients With Chronic Viral Hepatitis: Results From a Nationwide Swedish Population. Annals of Internal Medicine, 171(5), 318-327
Open this publication in new window or tab >>Lipophilic Statins and Risk for Hepatocellular Carcinoma and Death in Patients With Chronic Viral Hepatitis: Results From a Nationwide Swedish Population
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2019 (English)In: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 171, no 5, p. 318-327Article in journal (Refereed) Published
Abstract [en]

Background: Whether statin type influences hepatocellular carcinoma (HCC) incidence or mortality in chronic hepatitis B or C virus infection is unknown.

Objective: To assess the relationship between lipophilic or hydrophilic statin use and HCC incidence and mortality in a nationwide population with viral hepatitis.

Design: Prospective propensity score (PS)-matched cohort.

Setting: Swedish registers, 2005 to 2013.

Participants: A PS-matched cohort of 16 668 adults (8334 who initiated statin use [6554 lipophilic and 1780 hydrophilic] and 8334 nonusers) among 63 279 eligible adults.

Measurements: Time to incident HCC, ascertained from validated registers. Statin use was defined from filled prescriptions as 30 or more cumulative defined daily doses (cDDDs).

Results: Compared with matched nonusers, 10-year HCC risk was significantly lower among lipophilic statin users (8.1% vs. 3.3%; absolute risk difference [RD], -4.8 percentage points [95% CI, -6.2 to -3.3 percentage points]; adjusted subdistribution hazard ratio [aHR], 0.56 [CI, 0.41 to 0.79]) but not hydrophilic statin users (8.0% vs. 6.8%; RD, -1.2 percentage points [CI, -2.6 to 0.4 percentage points]; aHR, 0.95 [CI, 0.86 to 1.08]). The in- verse association between lipophilic statins and HCC risk seemed to be dose-dependent. Compared with nonusers, 10-year HCC risk was lowest with 600 or more lipophilic statin cDDDs (8.4% vs. 2.5%; RD, -5.9 percentage points [CI, -7.6 to -4.2 percentage points]; aHR, 0.41 [CI, 0.32 to 0.61]), and 10-year mortality was significantly lower among both lipophilic (15.2% vs. 7.3%; RD, -7.9 percentage points [CI, -9.6 to -62 percentage points]) and hydrophilic (16.0% vs. 11.5%; RD, -4.5 percentage points [CI, -6.0 to -3.0 percentage points]) statin users.

Limitation: Lack of lipid, fibrosis, or HCC surveillance data.

Conclusion: In a nationwide viral hepatitis cohort, lipophilic statins were associated with significantly reduced HCC incidence and mortality. An association between hydrophilic statins and reduced risk for HCC was not found. Further research is needed to determine whether lipophilic statin therapy is feasible for prevention of HCC.

Place, publisher, year, edition, pages
American College of Physicians, 2019
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-76548 (URN)10.7326/M18-2753 (DOI)000484610900004 ()31426090 (PubMedID)2-s2.0-85072077551 (Scopus ID)
Funder
Stockholm County Council
Note

Funding Agencies:

North American Training Grant from the American College of Gastroenterology  

Research ALF grant from Region Örebro County  OLL-683801 

National Institutes of Health  K23 DK099681  K24 DK078772

Available from: 2019-09-20 Created: 2019-09-20 Last updated: 2019-09-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7248-0910

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