Monitoring and comorbidities in patients with chronic hepatitis B currently treated with nucleos(t)ide analogs
Spyros Siakavellas 1 , John Goulis 2 , Spilios Manolakopoulos 1 3 , Christos Triantos 4 , Nikolaos Gatselis 5 , Eva Tsentemidou 2 , Hariklia Kranidioti 3 , Κonstantinos Ζisimopoulos 4 , Christos Τsoulas 6 , George Dalekos 5 , George Papatheodoridis 1
Affiliations
Affiliations
1
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, "Laiko" General Hospital of Athens, Athens (Spyros Siakavellas, Spilios Manolakopoulos, George Papatheodoridis).
2
4 Department of Internal Medicine, Medical School of Aristotle University of Thessaloniki (John Goulis, Eva Tsentemidou).
3
2 Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital, Athens (Spilios Manolakopoulos, Hariklia Kranidioti).
4
Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, Rio (Christos Triantos, Konstantinos Zisimopoulos).
5
Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa (Nikolaos Gatselis, George Dalekos).
6
Medical Department, Gilead Sciences Hellas (Christos Tsoulas), Greece.
Background: Long-term monotherapy with nucleos(t)ide analogs (NAs) represents the treatment option for the majority of patients with chronic hepatitis B (CHB), an aging population with a greater likelihood of comorbidities. We assessed the prevalence of concurrent non-hepatic diseases and the safety monitoring in a large cohort of CHB patients receiving NAs and their potential impact on disease outcomes.
Methods: We included 500 consecutive CHB patients from 5 major tertiary Greek centers, under long-term therapy with an NA. Epidemiological/clinical characteristics and data on concomitant disease, drug use and investigations ordered were collected.
Results: The mean age was 58 years and 66% were male. Most patients were receiving tenofovir disoproxil fumarate (TDF, 60%) or entecavir (ETV, 37%) monotherapy. Decompensated cirrhosis at baseline was present in 10%, while hepatocellular carcinoma (HCC) under therapy developed in 21 patients. The median duration of total NA therapy was 56 and of latest therapy 42 months. The most common (prevalence >10%) comorbidities were hypertension (28%), non-HCC cancer(s) (12%), and diabetes (11%). Patients with a longer duration of latest therapy (≥4 vs. <4 years) were older (mean age: 58 vs. 56 years, P=0.004), had more frequent history of prior use of NA(s) (53% vs. 35%, P<0.001), and less frequent liver decompensation (5% vs. 13%, P=0.008) and non-HCC cancers (8% vs. 15%, P=0.020). HCC developed more frequently in patients with than in those without diabetes (11% vs. 3%, P=0.022).
Conclusion: Greek CHB patients currently treated with NAs, almost exclusively ETV or TDF, are often older than 60 years, have several comorbidities, and thus require careful management.