Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection.

Abstract

UNLABELLED:

Chronic hepatitis B virus (HBV) infection leads to cirrhosis and hepatocellular carcinoma (HCC). Antiviral agents are thought to reduce HCC development, but agents such as lamivudine (LAM) have a high rate of drug resistance. We compared the incidence of HCC in 472 entecavir (ETV)-treated patients and 1,143 nontreated HBV patients (control group). Propensity score matching eliminated the baseline differences, resulting in a sample size of 316 patients per cohort. The drug mutation resistance was 0.8% (4/472) in the ETV group. The cumulative HCC incidence rates at 5 years were 3.7% and 13.7% for the ETV and control groups, respectively (P < 0.001). Cox proportional hazard regression analysis, adjusted for a number of known HCC risk factors, showed that patients in the ETV group were less likely to develop HCC than those in the control group (hazard ratio: 0.37; 95% confidence interval: 0.15-0.91; P = 0.030). Both cohorts were applied in three previously reported risk scales and risk scores were generated based on age, gender, cirrhosis status, levels of alanine aminotransferase, hepatitis B e antigen, baseline HBV DNA, albumin, and bilirubin. The greatest HCC risk reduction occurred in high-risk patients who scored higher on respective risk scales. In sub analyses, we compared treatment effect between nucleos(t)ide analogs, which included matched LAM-treated patients without rescue therapy (n = 182). We found HCC suppression effect greater in ETV-treated (P < 0.001) than nonrescued LAM-treated (P = 0.019) cirrhosis patients when they were compared with the control group.

CONCLUSION:

Long-term ETV treatment may reduce the incidence of HCC in HBV-infected patients. The treatment effect was greater in patients at higher risk of HCC.

• Authors: Tetsuya Hosaka, Fumitaka Suzuki, Masahiro Kobayashi, Yuya Seko, Yusuke Kawamura, Hitomi Sezaki, Norio Akuta, Yoshiyuki Suzuki, Satoshi Saitoh, Yasuji Arase, Kenji Ikeda, Mariko Kobayashi, Hiromitsu Kumada
• Journal: Hepatology (Baltimore, Md.) (Hepatology) Vol. 58 Issue 1 Pg. 98-107 (Jul 2013) ISSN: 1527-3350 [Electronic] United States
• PMID: 23213040 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 American Association for the Study of Liver Diseases.

Chemical References

• Lamivudine
• entecavir
• Guanine

Topics

• Adult
• Carcinoma, Hepatocellular (epidemiology, etiology, prevention & control)
• Cohort Studies
• Drug Resistance, Viral (genetics)
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hepatitis B, Chronic (complications, drug therapy)
• Humans
• Incidence
• Lamivudine (therapeutic use)
• Liver Neoplasms (epidemiology, etiology, prevention & control)
• Male
• Middle Aged
• Retrospective Studies