替诺或恩替治疗HBeAg血清转换在亚洲与非亚洲患者是低

StephenW

*TITLE: *HBeAg seroconversion is lower in Asian versus non-Asian patients
during treatment of chronic hepatitis B with tenofovir (TDF) or entecavir
(ETV)

*AUTHORS (FIRST NAME, LAST NAME): *_Kahee Jo_^1, 2 , Jennifer L. Dodge^3,
4 , Adrian Wadley^1, 2 , Adil E. Wakil^1, 2 , Jody L. Baron^3, 5 ,
Stewart Cooper^1, 2

*Institutional Author(s): *

*INSTITUTIONS (ALL): *1. Division of Hepatology and Center for Liver
Disease, California Pacific Medical Center, San Francisco, CA, United
States.
2. The El Hefni Liver Biorepository, California Pacific Medical Center,
San Francisco, CA, United States.
3. The Liver Center, University of California San Francisco, San
Francisco, CA, United States.
4. Department of Surgery, University of California San Francisco, San
Francisco, CA, United States.
5. Division of Gastroenterology, University of California San Francisco,
San Francisco, CA, United States.

*ABSTRACT BODY: *BACKGROUND/AIM Hepatitis B early antigen (HBeAg)
seroconversion (SC) is the principal treatment endpoint in HBeAg-positive
patients and the main therapeutic objective after viral suppression.
Uncertain SC rates (SCR) in Asian patients treated with modern
nucleos(t)ide analogs hamper prediction of treatment duration causing
patient trepidation. We conducted a single-center study to evaluate SCR
and virologic response (VR) among Asians and non-Asians treated with ETV
or TDF. METHODS In HBeAg-positive patients treated with ETV or TDF
monotherapy we estimated the cumulative probability of SC (HBeAb
synthesis and HBeAg loss) in 187 patients (83% Asian) and VR (serum HBV
DNA <1000IU/mL) in 145 patients (78% Asian). Cumulative probability of SC
and VR were calculated by ethnicity and compared using the log-rank test.
Cox regression modeled the risk of SC and VR; covariates included gender,
age, LAM exposure, HBV genotype and baseline ALT. RESULTS The respective
cumulative probabilities of SC on ETV or TDF at year 1, 2, 3, 4 and 5
were 5%, 10%, 16%, 25% and 35% in Asians, and 14%, 39%, 39%, 55% and 55%
in non-Asians; differing significantly after year 1 (p<0.002). After
adjusting for covariates the probability of SC remained significantly
lower in Asians versus non-Asians (HR 0.33, 95%Cl p=0.004). In non-
Asians, 2 and 3 year SCR were similar to rates reported in clinical
trials. The cumulative probabilities of VR on ETV or TDF at year 1, 2, 3
and 4 were 59%, 77%, 84% and 92% in Asians, and 84%, 88% and 100% in non-
Asians, which differed significantly (p?0.05) only in the univariate
analysis. VR was greater at 2 years for Asians treated with TDF vs ETV
(100% and 67%, p<0.001).
CONCLUSION The likelihood of SC is lower in
Asians versus non-Asians treated with ETV or TDF despite no overall
difference in VR. The SCR in Asians is lower than reported by clinical
trials in ethnically mixed populations. This is important information for
Asian patients and supports that factors other than VR impact Asian SCR.