Histological outcome for chronic hepatitis B patients treated with entecavir vs lamivudine-based therapy.

Abstract

AIM:

To compare the histological outcome of chronic hepatitis B (CHB) patients treated with entecavir (ETV) or lamivudine (LAM)-based therapy.

METHODS:

We conducted a retrospective analysis of data from 42 CHB patients with advanced fibrosis (baseline Ishak score ≥ 2) or cirrhosis who were treated with ETV or LAM-based therapy in Beilun People's Hospital, Ningbo between January 2005 and May 2012. The patients enrolled were more than 16 years of age and underwent a minimum of 12 mo of antiviral therapy. We collected data on the baseline characteristics of each patient and obtained paired liver biopsies pre- and post-treatment. The Knodell scoring system and Ishak fibrosis scores were used to evaluate each example. An improvement or worsening of necroinflammation was defined as ≥ 2-point change in the Knodell inflammatory score. The progression or regression of fibrosis was defined as ≥ 1-point change in the Ishak fibrosis score. The continuous variables were compared using t-test or Mann-Whitney test, and the binary variables were compared using χ(2) test or Fisher's exact test. The results of paired liver biopsies were compared with a Wilcoxon signed rank test.

RESULTS:

Nineteen patients were treated with ETV and 23 patients were treated with LAM therapy for a mean duration of 39 and 42 mo, respectively. After long-term antiviral treatment, 94.74% (18/19) of the patients in the ETV arm and 95.65% (22/23) in the LAM arm achieved an HBV DNA level less than 1000 IU/mL. The majority of the patients (94.74% in the ETV arm and 73.91% in the LAM arm) had normalized ALT levels. The median Knodell necroinflammatory score decreased from 11 to 0 in the patients receiving ETV, and the median Knodell score decreased from 9 to 3 in the patients receiving LAM (P = 0.0002 and < 0.0001, respectively). The median Ishak fibrosis score showed a 1-point reduction in ETV-treated patients and a 2-point reduction in LAM-treated patients (P = 0.0019 and 0.0205, respectively). The patients receiving ETV showed a more significant improvement in necroinflammation than the LAM-treated patients (P = 0.0003). However, there was no significant difference in fibrotic improvement between the two arms. Furthermore, two patients in each arm achieved a fibrosis score of 0 post-treatment, which indicates a full reversion of fibrosis after antiviral therapy.

CONCLUSION:

CHB patients with advanced fibrosis or cirrhosis benefit from antiviral treatment. ETV is superior to LAM therapy in improving necroinflammatory but not fibrotic outcome.

• Authors: Jia-Li Wang, Xin-Fang Du, Shao-Long Chen, Yi-Qi Yu, Jing Wang, Xi-Qi Hu, Ling-Yun Shao, Jia-Zhen Chen, Xin-Hua Weng, Wen-Hong Zhang
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 21 Issue 32 Pg. 9598-606 (Aug 28 2015) ISSN: 2219-2840 [Electronic] United States
• PMID: 26327767 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antiviral Agents
• DNA, Viral
• Lamivudine
• entecavir
• Guanine

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Biopsy
• Chi-Square Distribution
• China
• DNA, Viral (blood)
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hepatitis B virus (drug effects, genetics)
• Hepatitis B, Chronic (complications, drug therapy, pathology)
• Humans
• Lamivudine (therapeutic use)
• Liver (drug effects, pathology, virology)
• Liver Cirrhosis (drug therapy, pathology, virology)
• Male
• Middle Aged
• Retrospective Studies
• Time Factors
• Treatment Outcome
• Viral Load