Cirrhosis has no impact on therapeutic responses of entecavir for chronic hepatitis B
Wang, Pin-Chao; Wei, Tao-Yang; Tseng, Tai-Chung; Lin, Hans Hsienhong; Wang, Chia-Chi
European Journal of Gastroenterology & Hepatology: August 2017 - Volume 29 - Issue 8 - p 946–950
doi: 10.1097/MEG.0000000000000897
Original Articles: Hepatitis
Abstract
Author Information
Department of Gastroenterology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan
Correspondence to Chia-Chi Wang, MSc, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Road, Xindian Area, New Taipei City 23142, Taiwan Tel: +886 2 6628 9779 x2335; fax: +886 2 6628 9009; e-mail: [email protected]
Received November 13, 2016
Accepted April 10, 2017
Objective: As the efficacy of a direct antiviral agent is reduced in cirrhotic chronic hepatitis C patients, prolonged duration of treatment or addition of ribavirin is recommended to improve the rates of sustained virological response. However, the impact of cirrhosis on the efficacy of antiviral treatment for chronic hepatitis B (CHB) remained unclear.
Patients and methods: This retrospective cohort study screened entecavir (ETV)-treated CHB patients in Taipei Tzu Chi Hospital from January 2007 till October 2014. The diagnosis of cirrhosis was made on the basis of clinical/imaging or histologic findings. The primary endpoints were hepatitis B e antigen (HBeAg) loss in HBeAg-positive patients and undetectable hepatitis B virus (HBV) DNA in the overall study population. Initial virological response is defined as undetectable HBV DNA at 1-year ETV treatment.
Results: A total of 381 (262 men; mean age: 49.6±12.9 years) CHB patients were recruited for the final analysis. Of these, 138 were cirrhotic. In 143 HBeAg-positive patients, there was no difference in the rates of 1- and 2-year HBeAg loss between cirrhotic and noncirrhotic patients (P=0.226 and 0.729, respectively). In the overall population, the rate of 1-year undetectable HBV DNA was higher in patients with cirrhosis than those without cirrhosis (76.1 vs. 64.2%, P=0.016). The rate of 2-year undetectable HBV DNA was not different between these two groups. Using multivariate logistic regression analysis, baseline HBV DNA levels (P=0.006) and HBeAg status (P=0.007), were associated with initial virological response, but not cirrhosis.
Conclusion: Therapeutic responses of ETV are not decreased in cirrhotic CHB patients. Thus, cirrhotic CHB patients can be treated with ETV without the need for dose adjustment.