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Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients with liver cirrhosis.

AbstractUNLABELLED:
Entecavir is a potent antiviral agent with high genetic barrier to resistance, hence it is currently recommended as first-line antiviral therapy for chronic hepatitis B (CHB). The aim of this study was to investigate the efficacy of entecavir on clinical outcomes and deaths. It was a retrospective-prospective cohort study based on two cohorts of patients. The entecavir cohort included consecutive CHB patients who had received entecavir 0.5 mg/day for at least 12 months. The historical control cohort included untreated patients recruited since 1997 who underwent routine clinical care. The primary outcome was the 5-year cumulative probability of hepatic events, defined as any cirrhotic complications, hepatocellular carcinoma (HCC), and/or liver-related mortality. A total of 1,446 entecavir-treated patients (72% men; age, 51 ± 12 years; follow-up, 36 ± 13 months) and 424 treatment-naïve patients (65% men; age, 41 ± 13 years; follow-up, 114 ± 31 months) were studied. Overall, there was no difference in hepatic events between the entecavir and control cohorts. Among patients with liver cirrhosis (482 entecavir-treated, 69 treatment-naïve), entecavir-treated patients had reduced risks of all clinical outcomes when compared with treatment-naïve patients with cirrhosis after adjusted for model for end-stage liver disease score: hepatic events (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.34-0.78; P = 0.002), HCC (HR, 0.55; 95% CI, 0.31-0.99; P = 0.049), liver-related mortality (HR, 0.26; 95% CI, 0.13-0.55; P < 0.001), and all-cause mortality (HR, 0.34; 95% CI, 0.18-0.62; P < 0.001). Entecavir-treated patients with cirrhosis who failed to achieve undetectable hepatitis B virus DNA (105/482 [22%]) had comparable risk of hepatic events as the untreated patients.
CONCLUSION:
Entecavir therapy reduces the risks of hepatic events, HCC, liver-related and all-cause mortality of CHB patients with liver cirrhosis in 5 years, particularly among those who had maintained viral suppression.
AuthorsGrace Lai-Hung Wong, Henry Lik-Yuen Chan, Christy Wing-Hin Mak, Stanley King-Yeung Lee, Zoe Man-Yi Ip, Andrew Ting-Ho Lam, Henry Wing-Hang Iu, Joyce May-Sum Leung, Jennifer Wing-Yan Lai, Angeline Oi-Shan Lo, Hoi-Yun Chan, Vincent Wai-Sun Wong
JournalHepatology (Baltimore, Md.) (Hepatology) Vol. 58 Issue 5 Pg. 1537-47 (Nov 2013) ISSN: 1527-3350 [Electronic] United States
PMID23389810 (Publication Type: Journal Article)
CopyrightCopyright © 2013 American Association for the Study of Liver Diseases.
Chemical References
  • Antiviral Agents
  • DNA, Viral
  • entecavir
  • Guanine
Topics
  • Adult
  • Aged
  • Antiviral Agents (therapeutic use)
  • Carcinoma, Hepatocellular (prevention & control)
  • DNA, Viral (blood)
  • Female
  • Guanine (analogs & derivatives, therapeutic use)
  • Hepatitis B, Chronic (complications, drug therapy, mortality, virology)
  • Humans
  • Liver Cirrhosis (virology)
  • Liver Neoplasms (prevention & control)
  • Male
  • Middle Aged
  • Prospective Studies
  • Retrospective Studies

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