Clinical outcomes of lamivudine-adefovir therapy in chronic hepatitis B cirrhosis.

Abstract

GOALS:

To determine the clinical outcome of chronic hepatitis B cirrhotics on antiviral therapy.

BACKGROUND:

The long-term outcome of hepatitis B cirrhotics on therapy remains to be characterized.

METHODS:

A large clinic cohort of chronic hepatitis B cirrhotic patients were enrolled in a treatment program of lamivudine ± adefovir therapy. Patients were analyzed for clinical outcomes, and predictors of these outcomes were evaluated by multivariate analysis. Clinical outcomes of ascites, encephalopathy, hepatocellular carcinoma (HCC), and progression in Child-Pugh score, Model for End-stage Liver Disease score, and mortality were assessed. Data were analyzed by Kaplan-Meier graphs, log-rank test, and Cox regression.

RESULTS:

Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated cirrhosis. At 5 years, the mean survival was 83.6%, development of ascites, HCC, encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%, and 16.9%, respectively. The overall progression of liver-related complications was 32.8% at 5 years. Multivariate analysis showed that ascites, albumin ≤28 g/L, Child-Pugh score ≥7.9, Model for End-stage Liver Disease score ≥10.9 were significantly associated with liver-related complications. Low albumin and low hepatitis B virus DNA were independent factors for liver-associated mortality. Lamivudine resistance did not affect mortality or liver disease progression. When stratified by Child-Pugh status, the mean survival of those with Child C cirrhosis was worse than Child A and B cirrhosis (P<0.001, log-rank test). Early deaths (≤12 mo) were due to liver failure or sepsis, whereas deaths ≥12 mo were mainly due to HCC.

CONCLUSION:

Decompensated chronic hepatitis B cirrhotics may suffer early mortality despite antiviral treatment, and therefore should be considered for early liver transplantation.

• Authors: Seng Gee Lim, Myat Oo Aung, Belinda Mak, Dede Sutedja, Yin Mei Lee, Guan Huei Lee, Mark Fernandes, How Cheng Low, Vincent Lai, Yock Young Dan
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 45 Issue 9 Pg. 818-23 (Oct 2011) ISSN: 1539-2031 [Electronic] United States
• PMID: 21921845 (Publication Type: Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• Organophosphonates
• Lamivudine
• adefovir
• Adenine

Topics

• Adenine (analogs & derivatives, therapeutic use)
• Aged
• Antiviral Agents (therapeutic use)
• Cohort Studies
• Disease Progression
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Hepatitis B, Chronic (drug therapy, physiopathology)
• Humans
• Kaplan-Meier Estimate
• Lamivudine (therapeutic use)
• Liver Cirrhosis (drug therapy, physiopathology, virology)
• Male
• Middle Aged
• Multivariate Analysis
• Organophosphonates (therapeutic use)
• Proportional Hazards Models
• Prospective Studies
• Risk Factors
• Severity of Illness Index
• Survival Rate
• Treatment Outcome