Skip to main content Accessibility help
×
Home

Real-world study on clinical outcomes of nucleos(t)ide analogues antiviral therapy in patients with chronic hepatitis B

  • Y. Sun (a1), Y. Zhang (a2), Y. Xu (a1), M. Shu (a2), K. Bonroy (a3), H. Qiu (a2) and W. Cai (a1)...

Abstract

Nucleos(t)ide analogues (NAs) are widely used for antiviral therapy in patients with chronic hepatitis B (CHB), but real-world data on treatment patterns and long-term clinical outcomes are not always available. Using data from electronic medical records between January 2011 and December 2016 in Shanghai, China, we evaluated patient characteristics, treatment patterns and clinical outcomes in patients with CHB. There were 6688 patients in the study cohort. The incidences of cirrhosis and hepatocellular carcinoma (HCC) were 41.0‰ and 6.8‰ person-years, respectively. There were more cirrhosis and HCC cases among patients who had shorter NA treatment duration (<365 days), or who were less compliant (<80%). In addition, increased risk of cirrhosis and HCC was observed in patients who did not achieve hepatitis B surface antigen (HBsAg) loss/seroconversion. Moreover, patients with cirrhosis developed after antiviral treatments had a higher incidence of HCC (adjusted hazard ratio 15.86, 95% confidence interval 7.35–34.24). Good compliance with treatment and longer treatment duration significantly decreased the risk of developing cirrhosis and HCC. HBsAg loss seemed to be a protective factor for cirrhosis/HCC in NAs-treated patients with CHB, and cirrhosis was a confirmed risk factor for HCC development as expected.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Real-world study on clinical outcomes of nucleos(t)ide analogues antiviral therapy in patients with chronic hepatitis B
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Real-world study on clinical outcomes of nucleos(t)ide analogues antiviral therapy in patients with chronic hepatitis B
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Real-world study on clinical outcomes of nucleos(t)ide analogues antiviral therapy in patients with chronic hepatitis B
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: W. Cai, E-mail: carieyc@hotmail.com

Footnotes

Hide All
*

Ye Sun and Yongjing Zhang contributed equally to this work as first authors.

Footnotes

References

Hide All
1.Stanaway, JD et al. (2016) The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet 388, 10811088.
2.Mokdad, AA et al. (2014) Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC Medicine 12, 145.
3.Global Burden of Disease Cancer Collaboration (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncology 3, 524548.
4.World Health Organization (2017) Global Hepatitis Report 2017. Geneva: World Health Organization.
5.Fattovich, G, Bortolotti, F and Donato, F (2008) Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. Journal of Hepatology 48, 335352.
6.Chang, TT et al. (2010) Long-term entecavir therapy results in the reversal of fibrosis/cirrhosis and continued histological improvement in patients with chronic hepatitis B. Hepatology 52, 886893.
7.Dienstag, JL et al. (2003) Histological outcome during long-term lamivudine therapy. Gastroenterology 124, 105117.
8.Ahn, J et al. (2016) Lower observed hepatocellular carcinoma incidence in chronic hepatitis B patients treated with entecavir: results of the ENUMERATE study. American Journal of Gastroenterology 111, 12971304.
9.Triolo, M, Della Corte, C and Colombo, M (2014) Impact of HBV therapy on the incidence of hepatocellular carcinoma. Liver International 34(Suppl. 1), 139145.
10.Riveiro-Barciela, M et al. (2017) Effectiveness and safety of entecavir or tenofovir in a Spanish cohort of chronic hepatitis B patients: validation of the page-B score to predict hepatocellular carcinoma. Digestive Diseases and Sciences 62, 784793.
11.Hosaka, T et al. (2013) Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection. Hepatology 58, 98107.
12.Iloeje, UH, Yang, HI and Chen, CJ (2012) Natural history of chronic hepatitis B: what exactly has REVEAL revealed? Liver International 32, 13331341.
13.Yang, HI et al. (2011) Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): development and validation of a predictive score. Lancet Oncology 12, 568574.
14.Iloeje, UH et al. (2006) Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology 130, 678686.
15.Lee, MH et al. (2013) Prediction models of long-term cirrhosis and hepatocellular carcinoma risk in chronic hepatitis B patients: risk scores integrating host and virus profiles. Hepatology 58, 546554.
16.Chien, J et al. (2016) Risk and predictors of hepatocellular carcinoma for chronic hepatitis B patients with newly developed cirrhosis. Journal of Gastroenterology and Hepatology 31, 19711977.
17.European Association for the Study of the Liver (2017) EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. Journal of Hepatology 67, 370398.
18.Lieveld, FI et al. (2013) Patient adherence to antiviral treatment for chronic hepatitis B and C: a systematic review. Annals of Hepatology 12, 380391.
19.Beste, LA et al. (2015) Trends in burden of cirrhosis and hepatocellular carcinoma by underlying liver disease in US veterans, 2001–2013. Gastroenterology 149, 14711482, e1475; quiz e1417-1478.
20.Fattovich, G et al. (2004) Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 127, S35S50.
21.Ieluzzi, D et al. (2014) Progression to cirrhosis, hepatocellular carcinoma and liver-related mortality in chronic hepatitis B patients in Italy. Digestive and Liver Disease 46, 427432.
22.Chen, CJ et al. (2006) Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 295, 6573.
23.Kim, SU et al. (2014) Histological subclassification of cirrhosis can predict recurrence after curative resection of hepatocellular carcinoma. Liver International 34, 10081017.
24.Terrault, NA et al. (2016) AASLD guidelines for treatment of chronic hepatitis B. Hepatology 63, 261283.
25.Liu, J et al. (2014) Spontaneous seroclearance of hepatitis B seromarkers and subsequent risk of hepatocellular carcinoma. Gut 63, 16481657.
26.Kim, GA et al. (2014) HBsag seroclearance after nucleoside analogue therapy in patients with chronic hepatitis B: clinical outcomes and durability. Gut 63, 13251332.
27.Lim, TH et al. (2015) Serological and clinical outcomes of horizontally transmitted chronic hepatitis B infection in New Zealand Maori: results from a 28-year follow-up study. Gut 64, 966972.
28.Yang, H-I et al. (2002) Hepatitis B e antigen and the risk of hepatocellular carcinoma. New England Journal of Medicine 347, 168174.
29.Cho, JY et al. (2014) Patients with chronic hepatitis B treated with oral antiviral therapy retain a higher risk for HCC compared with patients with inactive stage disease. Gut 63, 19431950.
30.Zoutendijk, R et al. (2013) Virological response to entecavir is associated with a better clinical outcome in chronic hepatitis B patients with cirrhosis. Gut 62, 760765.
31.Sinn, DH et al. (2015) Hepatocellular carcinoma risk in chronic hepatitis B virus-infected compensated cirrhosis patients with low viral load. Hepatology 62, 694701.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed