|
- 现金
- 62111 元
- 精华
- 26
- 帖子
- 30441
- 注册时间
- 2009-10-5
- 最后登录
- 2022-12-28
|
Long-term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus-related cirrhosis
Jeong Won Jang1,9,
Jong Young Choi1,9,*,
Young Seok Kim2,9,
Hyun Young Woo3,9,
Sung Kyu Choi4,9,
Chang Hyeong Lee5,9,
Tae Yeob Kim6,9,
Joo Hyun Sohn6,9,
Won Young Tak7,9 and
Kwang-Hyub Han8,9
DOI: 10.1002/hep.27723
Copyright © 2015 American Association for the Study of Liver Diseases
Issue Vol. 61 Issue 2 Hepatology
1 Departments of Internal Medicine, The Catholic University of Korea, College of Medicine
2 Soonchunhyang University College of Medicine
3 Pusan National University Hospital
4 Chonnam National University Medical School
5 School of Medicine, Catholic University of Daegu
6 Hanyang University Guri Hospital
7 Kyungpook National University Hospital
8 Yonsei University College of Medicine
9 Liver Cirrhosis Clinical Research Center (LCCRC)
*Corresponding author: Jong Young Choi, M.D. Division of Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Republic of Korea E-mail: [email protected] Telephone: +82-2-2258-2075, Fax: +82-2-3481-4025
ABSTRACT
The effect of viral suppression on long-term disease outcome after decompensation in patients with hepatitis B virus (HBV)-related cirrhosis has not been established. The aim of this study was to determine the long-term effect of antiviral therapy in patients with HBV-related decompensated cirrhosis. This was a multicenter, prospective, inception cohort study of 707 patients who presented with first-onset decompensated complications, including 284 untreated patients and 423 antiviral-treated patients (58 previously treated, 253 with early treatment, and 112 with delayed treatment). The primary endpoint was 5-year liver transplantation (LT)-free survival. Secondary endpoints included virologic/serologic response and improvement in liver function. Despite baseline high HBV activity and worse liver function, antiviral-treated patients had significantly better transplant-free survival than untreated patients (5-year survival rates of 59.7% vs. 46.0%, respectively), with more apparent benefits from antivirals in Child-Turcotte-Pugh class B/C and high-viremia groups. The 5-year cumulative rate of virologic response and HBeAg seroconversion in antiviral-treated patients was 14.2% and 49.1%, respectively. A significant improvement in liver function was observed in treated versus untreated patients, with 33.9% of treated patients delisted for LT. Patients with early treatment had better clinical outcomes than those with delayed treatment. Survival was dependent on antiviral response, being significantly better in responders than in non-responders or untreated cases. The initial benefit of antiviral therapy was negated over time in non-responders. Antiviral treatment and maintained virologic response remained independently predictive of survival. The study results were corroborated by propensity score-matching analysis. Conclusion: Antiviral therapy significantly modifies the natural history of decompensated cirrhosis, improving liver function and increasing survival. The results underscore the importance of promptly administering potent antiviral drugs to patients under consideration for LT. This article is protected by copyright. All rights reserved.
|
|
发表于 2015-1-31 06:36