Nonselective beta blockers may protect against liver cancer in patients with cirrhosis

Nonselective beta-blockers (NSBBs), including carvedilol, appear to lower the risk of hepatocellular cancer (HCC) in patients with cirrhosis, according to a study.

The study drew data from the Cerner Health Facts database in the United States and included 107,428 eligible patients. Researchers applied Kaplan-Meier estimate, Cox proportional hazards regression, and propensity score matching (PSM) to estimate the risk of HCC in relation to the use of carvedilol, nadolol, or propranolol vs nonuse of beta blockers.

The cumulative incidence of HCC through 100 months was significantly lower among patients exposed to NSBBs than among those who did not use beta blockers. In propensity-matched score cohorts, the cumulative incidence rates were 11.24 percent among carvedilol users vs 15.69 percent among beta-blocker nonusers, 27.55 percent among nadolol users vs 32.11 percent among beta-blocker nonusers, and 26.17 percent among propranolol users vs 28.84 percent among beta-blocker  nonusers (p<0.0001 for all).

Multivariable Cox models confirmed the protective benefit of NSBBs. The risk of developing HCC decreased by 39 percent with carvedilol (hazard ratio [HR], 0.61, 95 percent confidence interval [CI], 0.51–0.73), by 26 percent with nadolol (HR, 0.74, 95 percent CI, 0.63–0.87), by 25 percent with propranolol (HR, 0.75, 95 percent CI, 0.66–0.84).

The results were consistent in subgroup analysis, where NSBBs reduced the risk of HCC both in cirrhosis with complications and in nonalcoholic cirrhosis.

Further randomized controlled studies that compare the incidence of HCC among NSBBs are required in order to establish which NSBB is the best option to prevent HCC in cirrhosis.