| SUMMARY AND COMMENT | GASTROENTEROLOGY June 25, 2015 AntiviralTherapy Improves Survival in Hepatitis B–Related Decompensated Cirrhosis Atif Zaman, MD, MPH Reviewing Jang JW et al., Hepatology 2015 Jun 61:1809 [p=18, null, left]The treatment benefit was greatest in patients with Child-Pugh B/C classification and high HBV DNA levels. Potent antivirals such as tenofovir and entecavir are effective in suppressing hepatitis B virus (HBV) in patients with compensated liver disease. A few small, mainly retrospective studies have suggested that in individuals with decompensated cirrhosis, these agents are safe and may improve liver function in the short term. In a prospective, longitudinal study, researchers evaluated the long-term efficacy of antiviral therapy in patients with HBV-related decompensated cirrhosis. Participants were patients presenting to one of seven South Korean referral centers between 2005 and 2012 with an initial episode of hepatic decompensation (e.g., ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, encephalopathy, variceal bleeding). They were followed through 2013, with laboratory testing at least once every 3 to 6 months and imaging as necessary. Of the 707 participants, 284 remained untreated and 423 were treated (58 already on treatment, 253 with early initiation, 112 with postponed initiation). At baseline, treated patients had higher HBV DNA levels and poorer liver function. Despite this, the 5-year transplant-free survival rate was better in the treated group than in the untreated group (P=0.0098). Furthermore, the rate was higher for the early-initiation group than for the untreated group (59.7% vs. 46.0%; P=0.0070). The greatest benefit of treatment was among patients with Child-Pugh B/C classification and high HBV DNA levels. In addition, 40% of the treated patients were removed from the transplant waiting list because of improved liver function. | Comment Although this study was not randomized (randomization would likely have been unethical), the findings verify those of earlier, smaller, retrospective studies suggesting that HBV-infected patients with decompensated cirrhosis benefit from prompt initiation of antiviral therapy. Starting early is key: Most deaths in treated patients occurred ≤6 months after treatment initiation, suggesting that liver function takes many months to recover after antiviral therapy is begun. |
Editor Disclosures at Time of Publication | Disclosures for Atif Zaman, MD, MPH at time of publication | | Nothing to disclose |
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Citation(s):
Jang JW et al. Long-term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus–related cirrhosis. Hepatology 2015 Jun; 61:1809. (http://dx.doi.org/10.1002/hep.27723) | 
发表于 2015-6-27 12:56
