恩替卡韦治疗HBeAg阴性慢性乙型肝炎患者的代偿性肝硬化中断

StephenW

Clinical outcomes after interruption of entecavir therapy in HBeAg-negative chronic hepatitis B patients with compensated cirrhosis

    Y. C. Chen1, C. Y. Peng2, W. J. Jeng1, R. N. Chien3 andY. F. Liaw1,*

Article first published online: 18 SEP 2015

DOI: 10.1111/apt.13409

© 2015 John Wiley & Sons Ltd

Issue
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Alimentary Pharmacology & Therapeutics

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    1    Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
    2    School of Medicine, Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
    3    Liver Research Unit, Chang Gung Memorial Hospital and University, Keelung, Taiwan

* Correspondence to:
Prof. Y. F. Liaw, Liver Research Unit, Chang Gung Memorial Hospital, 199, Tung Hwa North Road, Taipei 105, Taiwan.
E-mail: [email protected]

    This article was accepted for publication after full peer-review.


Background

Long-term nucleos(t)ide analogues therapy may reduce hepatocellular carcinoma (HCC) in chronic hepatitis B patients with advanced fibrosis or cirrhosis.
Aim

To investigate in a retrospective–prospective study whether this beneficial effect would be reduced in cirrhotic patients who discontinued a successful course of entecavir (ETV) therapy.
Methods

The study included 586 hepatitis B e antigen (HBeAg)-negative patients with compensated cirrhosis, mean age of 53.8 ± 10 years and 81% males, treated with ETV for at least 12 months. After ETV therapy for 46.5 ± 22.9 months, 205 patients who achieved hepatitis B virus (HBV) DNA suppression discontinued therapy. The clinical outcomes were assessed and HCC incidence was compared between propensity score (PS)-matched patients who continued and patients who discontinued ETV therapy by Asian Pacific Association for the Study of Liver stopping rule.
Results

During a mean duration of 59.3 ± 19 months after start of ETV therapy, nine and six HCC developed in an estimated annual incidence of 2.3% and 1.6% in 154 PS-matched patients who continued and who discontinued ETV therapy, respectively (P = 0.587). Multivariate Cox proportional hazards regression analyses showed that age (HR 1.065, P < 0.001) and HBV DNA (HR 1.216, P = 0.048) were the significant factors for HCC development. The rates of adverse clinical outcomes were comparable.
Conclusions

The clinical outcomes, including HCC, after cessation of a successful course of entecavir therapy in patients with compensated cirrhosis were comparable to those who continued therapy. The results suggest that this strategy of finite therapy is safe and a feasible alternative to indefinite therapy, especially in a low resources setting.

StephenW

恩替卡韦治疗HBeAg阴性慢性乙型肝炎患者的代偿性肝硬化中断后的临床结果

    YC臣1，CY鹏2，WJ Jeng1，RN Chien3安迪。 F. Liaw1，*

文章首次在网上公布：2015年9月18号

DOI：10.1111 / apt.13409

©2015年约翰·威利父子有限公司

问题
封面图片卷。 42第9期
消化系统药理学和治疗

早期的浏览（包含之前录制的网上版本发表在一期）
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    1肝脏研究单位，长庚医院，医药长庚大学，台湾台北
    医药，Hepatogastroenterology科，内科，中国医学大学附设医院，台中，台系2院
    3肝脏研究单位，长庚医院和大学，台湾基隆

*通讯作者：
教授YF廖，肝脏研究单位，长庚医院，199，通华北路，台北105，台湾。
电子信箱：[email protected]

    这篇文章被接受后满同行评审的出版物。


底

长期的核苷（酸）类似物治疗可降低慢性乙型肝炎患者的肝纤维化或肝硬化肝细胞癌（HCC）。
目标

要在回顾性，前瞻性研究探讨这一有益的效果是否会减少在谁停止恩替卡韦（ETV）治疗的成功当然肝硬化患者。
方法

该研究共纳入586乙型肝炎e抗原（HBeAg）阴性患者的代偿性肝硬化，平均53.8±10岁，81％为男性，恩替卡韦治疗至少12个月的年龄。后ETV疗法46.5±22.9个月的，谁取得乙型肝炎病毒（HBV）DNA抑制中止治疗205例。临床结果进行了评估和HCC发生率谁继续倾向得分（PS）项匹配的病人和谁停止ETV治疗由亚太协会肝脏停止规则的研究患者进行了比较。
结果

在59.3±19个月ETV治疗，九和六肝癌的2.3％和154 PS匹配的患者的1.6％，估计每年发病开发开始后，平均持续时间谁继续和谁停止ETV治疗，分别为（P = 0.587 ）。多因素Cox比例风险回归分析显示，年龄（HR 1.065，P <0.001）和HBV-DNA（HR 1.216，P = 0.048）是显著因素，肝癌的发展。的不良临床结局发生率是相当的。
结论

临床结果，包括肝癌，恩替卡韦停止治疗的患者的代偿性肝硬化成功当然后是可比那些谁的持续治疗。结果表明，有限的治疗这种策略是安全的，一个可行的替代无限期疗法，特别是在低的资源设置。

价格合适

WHO的指南也说乙肝引起的肝硬化要终身服药。 估计没有几个人敢冒险停药吧

StephenW

回复 价格合适 的帖子

台湾，尤其是廖教授，停止不是问题，即使在代偿性肝硬化. 欧洲，美国不同意停止.