替诺福韦治疗慢性HBV可降低肝细胞癌的风险

StephenW

Tenofovir for chronic HBV reduces risk for hepatocellular carcinoma

July 16, 2018


In patients with chronic hepatitis B infection, treatment with tenofovir disoproxil may significantly reduce the risk for hepatocellular carcinoma, according to study findings published in The Journal of Infectious Diseases.

Among hundreds of patients included in the study, tenofovir disoproxil (TDF) was significantly associated with an 8-year hepatocellular carcinoma cumulative (HCC) incidence rate reduction among cirrhotic and non-cirrhotic patients, Mindie H. Nguyen, MD, MAS, professor of medicine in the division of gastroenterology and hepatology at Stanford University Medical Center, and colleagues reported.

“Chronic hepatitis B (CHB) affects approximately 250 million people worldwide,” Nguyen and colleagues wrote. “While mostly endemic to Asia and Africa, CHB is also prevalent in the United States among many immigrant groups and has been estimated by the National Health and Nutrition Examination Survey to affect approximately 0.8 to 1.4 million persons.”

According to the study, data concerning liver-related outcomes associated with TDF are limited in the Asian population. Nguyen and colleagues conducted a retrospective cohort study of 6,914 CHB monoinfected adults — older than 18 years — who had not undergone transplantation surgery from six U.S. referral, community medical centers from 2000 to 2016 and the Taiwan community-based REVEAL-HBV cohort.
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Initially, 774 patients received TDF therapy, whereas 6,140 were untreated. Nguyen and colleagues balanced the groups using age, sex, hepatitis B e-antigen, HBV DNA, alanine aminotransferase (ALT), baseline cirrhosis state and follow-up time to match 591 patients in the treated and nontreated groups. After propensity score matching, the study population was on average 44.84 +/- 13.09 years old, 59.31% male and 95.43% Asian.

In the untreated group, Nguyen and colleagues determined that the 8-year cumulative HCC incidence was significantly higher at 20.13% compared with 4.69% in the treated group (P < 0.0001). According to the researchers, cirrhosis was a significant predictor for HCC (adjusted HR = 5.36; 95% CI, 2.73-10.51). When adjusting for age, sex, HBV DNA, ALT and study site, TDF therapy was associated with a 77% HCC risk reduction in patients with cirrhosis (aHR = 0.23; 95% CI, 0.56-0.92). Additionally, patients without cirrhosis receiving TDF had a 73% HCC risk reduction (aHR = 0.27; 95% CI, 0.07-0.98).

“Our findings confirm that TDF for Asian patients with CHB is an appropriate and beneficial treatment for cirrhotic and non-cirrhotic CHB patients with active disease,” Nguyen and colleagues wrote. “We encourage further research in other ethnicities at risk for CHB to determine how these findings relate to other groups of patients.”– by Marley Ghizzone

Disclosures: Nguyen reports receiving research support from Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceutical, National Cancer Institute, Pfizer, B.K. Kee Foundation and Asian Health Foundation and serving as an advisory board member or consultant for Dynavax Laboratories, Gilead Sciences, Intercept Pharmaceuticals, Alnylam Pharmaceuticals, Bristol-Myers Squibb, Novartis and Janssen Pharmaceuticals. Please see the study for all other authors’ relevant financial disclosures.

StephenW

替诺福韦治疗慢性HBV可降低肝细胞癌的风险

2018年7月16日


根据发表在“传染病杂志”上的研究结果，对于慢性乙型肝炎感染患者，使用替诺福韦地索普西治疗可能会显着降低肝细胞癌的风险。

在研究中包括的数百名患者中，替诺福韦地索普西（TDF）与肝硬化和非肝硬化患者的8年肝细胞癌累积（HCC）发病率降低显着相关，Mindie H. Nguyen，MD，MAS，斯坦福大学医学中心的胃肠病学和肝病学的医学和同事报告。

“慢性乙型肝炎（CHB）影响全球约2.5亿人，”Nguyen及其同事写道。 “虽然亚洲和非洲大部分地区流行，但在许多移民群体中，CHB在美国也很普遍，并且根据全国健康和营养检查调查估计，CHB影响大约80到140万人。”

根据该研究，与TDF相关的肝脏相关结果的数据在亚洲人群中是有限的。 Nguyen及其同事对6,914名CHB单一感染成年人 - 年龄超过18岁 - 进行了一项回顾性队列研究，他们从2000年至2016年的六个美国转诊，社区医疗中心和台湾社区的REVEAL-HBV队列中未接受过移植手术。
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最初，774名患者接受了TDF治疗，而6,140名患者未接受治疗。 Nguyen及其同事使用年龄，性别，乙型肝炎e抗原，HBV DNA，丙氨酸氨基转移酶（ALT），基线肝硬化状态和随访时间来平衡这些组，以匹配治疗组和未治疗组中的591名患者。在倾向评分匹配后，研究人群平均为44.84 +/- 13.09岁，59.31％为男性，95.43％为亚洲人。

在未治疗组中，Nguyen及其同事确定8年累积HCC发生率显着高于20.13％，而治疗组为4.69％（P <0.0001）。据研究人员称，肝硬化是HCC的重要预测指标（调整后HR = 5.36; 95％CI，2.73-10.51）。在调整年龄，性别，HBV DNA，ALT和研究部位时，TDF治疗与肝硬化患者的77％HCC风险降低相关（aHR = 0.23; 95％CI，0.56-0.92）。此外，没有接受TDF的肝硬化患者的HCC风险降低73％（aHR = 0.27; 95％CI，0.07-0.98）。

“我们的研究结果证实，对于患有活动性疾病的肝硬化和非肝硬化CHB患者，亚洲CHB患者的TDF是一种合适且有益的治疗方法，”Nguyen及其同事写道。 “我们鼓励进一步研究CHB风险的其他种族，以确定这些发现与其他患者群体的关系。” - 作者：Marley Ghizzone

披露：Nguyen报告获得Bristol-Myers Squibb，Gilead Sciences，Janssen Pharmaceutical，National Cancer Institute，Pfizer，B.K。的研究支持。 Kee基金会和亚洲健康基金会，并担任Dynavax Laboratories，Gilead Sciences，Intercept Pharmaceuticals，Alnylam Pharmaceuticals，Bristol-Myers Squibb，Novartis和Janssen Pharmaceuticals的顾问委员会成员或顾问。有关所有其他作者的相关财务披露，请参阅该研究。

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