SUMMARY AND COMMENT | GASTROENTEROLOGY, INFECTIOUS DISEASES
June 3, 2020
Long-Term Outcomes in HBV Patients with Hepatitis B Surface Antigen Seroclearance
Atif Zaman, MD, MPH reviewing Anderson RT et al. Clin Gastroenterol Hepatol 2020 May 27
A meta-analysis supports use of seroclearance as a surrogate endpoint for improved clinical outcomes in patients with chronic HBV infection.
The treatment target for chronic hepatitis B virus (HBV) infection is hepatitis B surface antigen (HBsAg) seroclearance. However, the strength of the association between HBsAg seroclearance and improvement in long-term clinical outcomes is unclear.
To address this issue, researchers conducted a systematic review and meta-analysis, identifying 28 studies that assessed outcomes in nearly 190,000 HBV-infected patients with recorded HBsAg status. Long-term outcomes studied included hepatocellular carcinoma (HCC), hepatic decompensation, liver transplantation, and all-cause mortality. In the meta-analysis, random effects modeling was performed to calculate rate ratios.
During nearly 1.5 million person-years of follow-up, the incidence of any clinical event listed above was lower in those with HBsAg seroclearance compared with those with HBsAg persistence (0.2/1000 person-years vs. 2.5/1000 person-years). Pooled rate ratios indicated significantly reduced incidence for each clinical outcome in the seroclearance group versus the persistence group: 0.3 for HCC, 0.3 for hepatic decompensation, and 0.2 for liver transplantation and/or death. Interstudy heterogeneity was low, indicating consistency of results across studies.
Comment
This meta-analysis confirms that achieving seroclearance not only consistently improves liver-related outcomes in patients with HBV but also reduces mortality. Therefore, this study supports the use of HBsAg seroclearance as a valid surrogate marker for improved clinical outcomes.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Editor Disclosures at Time of Publication
Disclosures for Atif Zaman, MD, MPH at time of publication
Grant/Research Support
Merck
Citation(s):
Anderson RT et al. Association between seroclearance of hepatitis B surface antigen and long-term clinical outcomes of patients with chronic HBV infection: Systematic review and meta-analysis. Clin Gastroenterol Hepatol 2020 May 27; [e-pub]. (https://doi.org/10.1016/j.cgh.2020.05.041)