Tracey G Simon1, Jacqueline Henson2, Stephanie Osganian3, Ricard Masia4, Andrew T Chan5, Raymond T Chung6, Kathleen E Corey7. 1. Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Harvard Medical School, Boston Massachusetts; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston Massachusetts. 2. Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston Massachusetts. 3. Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston Massachusetts. 4. Harvard Medical School, Boston Massachusetts; Department of Pathology, Massachusetts General Hospital, Boston Massachusetts. 5. Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Harvard Medical School, Boston Massachusetts; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston Massachusetts; Broad Institute, Boston Massachusetts; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston Massachusetts. 6. Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Harvard Medical School, Boston Massachusetts; Broad Institute, Boston Massachusetts. 7. Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston Massachusetts; Harvard Medical School, Boston Massachusetts; Clinical and Translational Epidemiology Unit (CTEU), Massachusetts General Hospital, Boston Massachusetts. Electronic address: kcorey@partners.org.
Abstract
BACKGROUND & AIMS: There are few data from prospective studies on the effects of aspirin on fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS: We performed a prospective cohort study of 361 adults with biopsy-confirmed NAFLD, from 2006 through 2015, examined every 3-12 months for incident advanced fibrosis defined using serial measurements of validated indices (the Fibrosis-4, NAFLD fibrosis score, and aspartate aminotransferase to platelet ratio indices). Histologic analyses of liver biopsies collected at baseline were performed by a blinded pathologist. Information collected at baseline and at each examination included frequency and duration of aspirin and nonsteroidal anti-inflammatory drug (NSAID) use. Using multivariable-adjusted logistic regression, we estimated the association of aspirin use with prevalent steatohepatitis (NASH) and fibrosis. Using multivariable-adjusted Cox proportional hazards modeling, we estimated the association between aspirin use and risk for fibrosis progression. RESULTS: At enrollment, 151 subjects used aspirin daily. Compared with non-regular use, daily aspirin use was associated with significantly lower odds of NASH (adjusted odds ratio, 0.68; 95% CI, 0.37-0.89) and fibrosis (adjusted odds ratio, 0.54; 95% CI, 0.31-0.82). Among individuals with baseline F0-F2 fibrosis (n = 317), 86 developed advanced fibrosis over 3692 person-years. Daily aspirin users had significantly lower risk for developing incident advanced fibrosis vs non-regular users (adjusted hazard ratio [aHR], 0.63; 95% CI, 0.43-0.85). This relationship appeared to be duration dependent (adjusted P trend=.026), with the greatest benefit found with at least 4 years or more of aspirin use (aHR, 0.50; 95% CI, 0.35-0.73). Conversely, use of nonaspirin NSAIDs was not associated with risk for advanced fibrosis (aHR, 0.93; 95% CI, 0.81-1.05). CONCLUSIONS: In a prospective study of patients with biopsy-proven NAFLD, daily aspirin use was associated with less severe histologic features of NAFLD and NASH, and lower risk for progression to advanced fibrosis with time.
BACKGROUND & AIMS: There are few data from prospective studies on the effects of aspirin on fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS: We performed a prospective cohort study of 361 adults with biopsy-confirmed NAFLD, from 2006 through 2015, examined every 3-12 months for incident advanced fibrosis defined using serial measurements of validated indices (the Fibrosis-4, NAFLD fibrosis score, and aspartate aminotransferase to platelet ratio indices). Histologic analyses of liver biopsies collected at baseline were performed by a blinded pathologist. Information collected at baseline and at each examination included frequency and duration of aspirin and nonsteroidal anti-inflammatory drug (NSAID) use. Using multivariable-adjusted logistic regression, we estimated the association of aspirin use with prevalent steatohepatitis (NASH) and fibrosis. Using multivariable-adjusted Cox proportional hazards modeling, we estimated the association between aspirin use and risk for fibrosis progression. RESULTS: At enrollment, 151 subjects used aspirin daily. Compared with non-regular use, daily aspirin use was associated with significantly lower odds of NASH (adjusted odds ratio, 0.68; 95% CI, 0.37-0.89) and fibrosis (adjusted odds ratio, 0.54; 95% CI, 0.31-0.82). Among individuals with baseline F0-F2 fibrosis (n = 317), 86 developed advanced fibrosis over 3692 person-years. Daily aspirin users had significantly lower risk for developing incident advanced fibrosis vs non-regular users (adjusted hazard ratio [aHR], 0.63; 95% CI, 0.43-0.85). This relationship appeared to be duration dependent (adjusted P trend=.026), with the greatest benefit found with at least 4 years or more of aspirin use (aHR, 0.50; 95% CI, 0.35-0.73). Conversely, use of nonaspirin NSAIDs was not associated with risk for advanced fibrosis (aHR, 0.93; 95% CI, 0.81-1.05). CONCLUSIONS: In a prospective study of patients with biopsy-proven NAFLD, daily aspirin use was associated with less severe histologic features of NAFLD and NASH, and lower risk for progression to advanced fibrosis with time.
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