Tenofovir disoproxil fumarate reduces hepatocellular carcinoma, decompensation and death in chronic hepatitis B patients with cirrhosis
Ken Liu
Jonggi Choi
An Le
Terry Cheuk‐Fung Yip
Vincent Wai‐Sun Wong
Stephen Lam Chan
Henry Lik‐Yuen Chan
Mindie H. Nguyen
Young‐Suk Lim
Grace Lai‐Hung Wong
First published: 16 September 2019 https://doi.org/10.1111/apt.15499
Ken Liu, Jonggi Choi and An Le should be considered as joint first author.
Mindie H. Nguyen, Young‐Suk Lim, Grace Lai‐Hung Wong should be considered as joint senior author.
The Handling Editor for this article was Professor Geoffrey Dusheiko, and it was accepted for publication after full peer‐review.
Funding information:
This work was supported by the Investigator Sponsored Research of Gilead Sciences (Reference: IN‐US‐174‐3889).
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Summary
Background
Lamivudine and entecavir reduce hepatic events and death in chronic hepatitis B (CHB) patients with cirrhosis, but the impact of tenofovir disoproxil fumarate (TDF) is less well studied.
Aim
To investigate the effectiveness of TDF therapy in CHB patients with cirrhosis.
Methods
We studied TDF‐treated and untreated CHB patients with cirrhosis from three tertiary centres. TDF cohort included consecutive patients who received TDF for ≥12 months while the untreated cohort were historical controls receiving routine clinical care prior to the availability of anti‐viral therapy. The primary outcome was 5‐year cumulative probability of hepatocellular carcinoma (HCC) with secondary outcomes being hepatic decompensation and death or liver transplantation (LT).
Results
A total of 1088 (291 untreated and 797 TDF‐treated) patients were included in the study. Five‐year cumulative probabilities in untreated vs TDF‐treated cohorts were 14.9% vs 9.8% for HCC (P = .07), 22.3% vs 5.9% for decompensation (P < .01) and 13.1% vs 1.1% for death or LT (P < .01) respectively. On multivariable Cox regression, TDF treatment was independently associated with reduced risks of HCC (adjusted hazard ratio [aHR] 0.46, P < .01), decompensating events (aHR 0.28, P = .01) and death or LT (aHR 0.06, P < .01). On sensitivity analyses, these risk reductions with TDF treatment were consistently demonstrated regardless of severity of liver disease and prior anti‐viral treatment. TDF treatment led to sustained improvements in most validated prognostic scores for predicting HCC, decompensation and death.
Conclusions
Compared to untreated patients, TDF treatment reduces the risks of HCC, hepatic decompensation and death in CHB patients with cirrhosis at 5 years. 作者: StephenW 时间: 2019-9-19 22:53
替诺福韦地索普西富马酸盐减少慢性乙型肝炎肝硬化患者的肝细胞癌，失代偿和死亡
刘Ken
Jonggi Choi
安乐
Terry Cheuk-Fung Yip
Vincent Wai-Sun Wong
Stephen Lam Chan
Henry Lik-Yuen Chan
Mindie H. Nguyen
Young-Suk Lim
Grace Lai-Hung Wong
首次发表：2019年9月16日 https://doi.org/10.1111/apt.15499
Ken Liu，Jonggi Choi和An Le应被视为第一作者。
Mindie H. Nguyen，Young-Suk Lim，Grace Lai-Hung Wong应被视为联合资深作者。
本文的处理编辑器是Geoffrey Dusheiko教授，经过全面的同行评审后被接受发表。