Low-dose aspirin cuts risk of hepatoma, liver-related death in hepatitis patients

Last Updated: 2020-03-11

By Gene Emery

(Reuters Health) - In patients with chronic hepatitis B or C, long-term aspirin therapy at a daily dose below 161 mg lowers the risk of hepatocellular carcinoma by 31% and liver-related mortality by 27%, according to a Swedish registry-based study of 50,275 people.

The longer patients took aspirin, the greater the benefit. The reduction in hepatoma cases was 43% for those who had been taking aspirin for 5 years or more. It took about 3 years for the benefit to appear.

The reduction in liver-related mortality occurred over a 10-year span.

And while gastrointestinal bleeding is always a concern with aspirin use, the study's authors reported online Wednesday in The New England Journal of Medicine that bleeding rates were 7.8% for aspirin users versus 6.9% for aspirin non-users, a non-significant difference.

"Our findings are exciting because they provide evidence for the first time in a population-based study that low-dose aspirin use contributes to a significant, 31% lower risk of developing primary liver cancer. However, before aspirin can be recommended for this purpose, we need to have data from well-designed randomized controlled trials," chief author Dr. Tracey Simon, an Instructor of medicine and gastroenterology at Massachusetts General Hospital and Harvard Medical School, told Reuters Health by email.

"It is very important to weigh the potential risk of bleeding from aspirin, because that risk increases in patients with severe liver disease," she said.

"Our results were consistent regardless of sex, cause of hepatitis, or underlying compensated cirrhosis, which suggests that the benefits of aspirin may apply to a broad at-risk population," the researchers said.

"With a median of 7.9 years of follow-up, the estimated cumulative incidence of hepatocellular carcinoma (over 10 years) was 4.0% among aspirin users and 8.3% among nonusers of aspirin," they reported.

Ten-year liver-related mortality rates were 11.0% with aspirin and 17.9% without.

Three quarters of the volunteers had hepatitis C; the rest had hepatitis B.

Although hepatitis C can be eradicated and drugs can suppress hepatitis B, there's still an elevated risk of cancer or early mortality for such patients, particularly if they have advanced fibrosis.

The benefits were not sustained for patients who discontinued aspirin. Compared to people who kept taking it, those who stopped saw a 22% greater risk of hepatocellular carcinoma and a 31% elevated risk of liver-related death.

"The risk was also influenced by consistency of aspirin use," the researchers said. The overall incidence of hepatocellular carcinoma was 5.9% among inconsistent users and 1.1% among consistent users.

The odds of major gastrointestinal bleeding were statistically similar with low-dose aspirin use (3.6%) and without it (2.4%).

The presence of compensated cirrhosis did not make a notable difference in the risk of bleeding.

The study used prescription data to discern aspirin use. In Sweden, low-dose aspirin is only available by prescription usually at a dose of 75 mg or 160 mg. The database did not distinguish between the two doses, so it was not possible to determine which dose, if either, provided the most benefit.

Dr. Simon said most patients were probably taking 100 mg or less.

"Our goal is to find the lowest effective dose of aspirin that can produce meaningful liver cancer risk reduction," she said.

As for other liver conditions, "if it is found that aspirin also can prevent liver cancer development in alcohol-related liver disease and nonalcoholic fatty liver disease, then our findings are likely to be even more important," said Dr. Simon.

SOURCE: https://bit.ly/2VSKWJk The New England Journal of Medicine, online March 11, 2020.