- 现金
- 62111 元
- 精华
- 26
- 帖子
- 30437
- 注册时间
- 2009-10-5
- 最后登录
- 2022-12-28
|
本帖最后由 StephenW 于 2013-4-3 21:05 编辑
Gut 2013;62:760-765 doi:10.1136/gutjnl-2012-302024
Hepatology
Original article
Virological response to entecavir is associated with a better clinical outcome in chronic hepatitis B patients with cirrhosis
Roeland Zoutendijk1,
Jurrien GP Reijnders1,
Fabien Zoulim2,
Ashley Brown3,
David J Mutimer4,
Katja Deterding5,
Wolf Peter Hofmann6,
Joerg Petersen7,
Massimo Fasano8,
Maria Buti9,
Thomas Berg10,
Bettina E Hansen1,
Milan J Sonneveld1,
Heiner Wedemeyer5,
Harry L A Janssen1,
for the VIRGIL Surveillance Study Group
+ Author Affiliations
1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
2Department of Hepatology, Hospices Civils de Lyon; INSERM, U1052, Lyon University, Lyon, France
3Department of Hepatology and Gastroenterology, Imperial College London, London, UK
4NIHR Biomedical Research Unit and Centre for Liver Research, Queen Elizabeth Hospital, Birmingham, UK
5Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
6Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
7Ifi Institute, Asklepios Klinik St Georg, Hamburg, Germany
8Clinic of Infectious Diseases, University of Bari, Bari, Italy
9Department of Hepatology, Hospital Vall de Hebron and Ciberehd los Instituto Carlos III, Barcelona, Spain
10Department of Hepatology, University Clinic Leipzig, Leipzig, Germany
Correspondence to Professor Dr Harry L A Janssen, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, Room Ha 204, 3015 CE Rotterdam, The Netherlands; [email protected]
Contributors RZ: acquisition of data, analysis and interpretation of data, drafting and finalising the article. JR: acquisition of data, drafting and finalising the article. FZ, AB, DJM, KD, JP, WPH, MB, MF, TB, HW: acquisition of data, critical revision of draft of article and approval of final version. MJS: interpretation of data, drafting of the article and approval of final version. BEH: analysis and interpretation of data, critical revision of draft of article and approval of final version. HLAJ: study concept and design, study supervision, analysis and interpretation of data, drafting and finalising the article.
Revised 15 February 2012
Accepted 28 February 2012
Published Online First 5 April 2012
Abstract
Objective Entecavir (ETV) is a potent inhibitor of viral replication in chronic hepatitis B and prolonged treatment may result in regression of fibrosis. The aim of this study was to investigate the effect of ETV on disease progression.
Design In a multicentre cohort study, 372 ETV-treated patients were investigated. Clinical events were defined as development of hepatocellular carcinoma (HCC), hepatic decompensation or death. Virological response (VR) was defined as HBV DNA <80 IU/ml.
Results Patients were classified as having chronic hepatitis B without cirrhosis (n=274), compensated cirrhosis (n=89) and decompensated cirrhosis (n=9). The probability of VR was not influenced by severity of liver disease (p=0.62). During a median follow-up of 20 months (IQR 11–32), the probability of developing clinical events was higher for patients with cirrhosis (HR 15.41 (95% CI 3.42 to 69.54), p<0.001). VR was associated with a lower probability of disease progression (HR 0.29 (95% CI 0.08 to 1.00), p=0.05) which remained after correction for established risk factors such as age. The benefit of VR was only significant in patients with cirrhosis (HR 0.22 (95% CI 0.05 to 0.99), p=0.04) and remained after excluding decompensated patients (HR 0.15 (95% CI 0.03 to 0.81), p=0.03). A higher HBV DNA threshold of 2000 IU/ml was not associated with the probability of disease progression (HR 0.20 (95% CI 0.03 to 1.10), p=0.10).
Conclusion VR to ETV is associated with a lower probability of disease progression in patients with cirrhosis, even after correction for possible baseline confounders. When using a threshold of 2000 IU/ml, the association between viral replication and disease progression was reduced, suggesting that complete viral suppression is essential for nucleoside/nucleotide analogue treatment, especially in patients with cirrhosis.
|
|