美国社区与学术实践在接受恩替卡韦治疗慢性乙型肝炎患者

StephenW

Dig Dis Sci. 2018 Sep 20. doi: 10.1007/s10620-018-5281-3. [Epub ahead of print]
A Comparison Between Community and Academic Practices in the USA in the Management of Chronic Hepatitis B Patients Receiving Entecavir: Results of the ENUMERATE Study.
Lee HM1, Ahn J2, Kim WR3, Lim JK4, Nguyen M3, Pan CQ5, Kim D3, Mannalithara A3, Te H6, Trinh H7, Chu D8, Tran T9, Woog J10, Lok AS11.
Author information

1
    Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, 1200 E. Broad St., 14th Floor, P.O. Box 980341, Richmond, VA, 23298, USA. [email protected].
2
    Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA.
3
    Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA.
4
    Yale University, New Haven, CT, USA.
5
    Division of Gastroenterology and Hepatology, NYU Langone Health, NYU School of Medicine, New York, USA.
6
    Digestive Disease Center, University of Chicago, Chicago, IL, USA.
7
    San Jose Gastroenterology, San Jose, CA, USA.
8
    Albert Einstein College of Medicine, New York, NY, USA.
9
    Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
10
    Asian Health Foundation, Rochester, MN, USA.
11
    Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.

Abstract
BACKGROUND AND AIMS:

The management of chronic hepatitis B patients is not well characterized in real-world practice. We compared baseline characteristics of CHB patients on entecavir, the frequency of on-treatment monitoring, and the effectiveness of ETV treatment between academic and community practices.
METHODS:

Treatment-naïve CHB patients ≥18 years old, treated with ETV for ≥12 months from 2005 to 2013, in 26 community and academic practices throughout the USA were retrospectively evaluated.
RESULTS:

Of 841 patients enrolled, 658 (65% male, 83% Asian, median age 47, 9% with cirrhosis) met inclusion criteria. Half of the patients (52%) were from community practices. A lower percentage of patients in community practices had cirrhosis or liver cancer (5 vs. 14%). Community practices more often treated patients with baseline ALT < 2 × ULN. Over a median follow-up of 4 years, community practices were more likely to discontinue ETV with less frequent laboratory monitoring compared to academic practices. The 5-year cumulative probability of ALT normalization was greater among patients treated in community practices (70 vs. 50%, p < 0.001), but the 5-year cumulative probability of undetectable HBV DNA was lower (45 vs. 70%, p < 0.001) than those treated in academic practices.
CONCLUSION:

Academic practices saw CHB patients with more advanced liver disease, more often followed AASLD guidelines, and monitored patients on ETV treatment more frequently than community practices. While patients in community practices were less likely to achieve undetectable HBV DNA and more likely to achieve ALT normalization, the rates of HBeAg loss and seroconversion as well as HBsAg loss were similar.
KEYWORDS:

Antiviral therapy; Chronic HBV; HBeAg loss; HBsAg loss; Practice management

PMID:
    30238203
DOI:
    10.1007/s10620-018-5281-3

StephenW

Dig Dis Sci。 2018年9月20日doi：10.1007 / s10620-018-5281-3。 [提前打印]
美国社区与学术实践在接受恩替卡韦治疗慢性乙型肝炎患者中的比较：研究结果。
Lee HM1，Ahn J2，Kim WR3，Lim JK4，Nguyen M3，Pan CQ5，Kim D3，Mannalithara A3，Te H6，Trinh H7，Chu D8，Tran T9，Woog J10，Lok AS11。
作者信息

1
    弗吉尼亚联邦大学医学中心消化内科，肝脏病学和营养学系，1200 E. Broad St.，14th，P.O。 Box 980341，Richmond，VA，23298，USA。 [email protected]。
2
    美国俄勒冈州波特兰市俄勒冈健康与科学大学消化内科和肝脏病学系。
3
    美国加利福尼亚州斯坦福大学斯坦福大学消化内科和肝病学系。
4
    耶鲁大学，纽黑文，CT，美国。
五
    美国纽约纽约大学医学院Langone Health，消化内科和肝病学系。
6
    消化疾病中心，芝加哥大学，芝加哥，IL，美国。
7
    San Jose Gastroenterology，San Jose，CA，USA。
8
    艾伯特爱因斯坦医学院，纽约，纽约，美国。
9
    美国加利福尼亚州洛杉矶Cedars Sinai医学中心医学系。
10
    亚洲健康基金会，美国明尼苏达州罗切斯特市。
11
    美国密歇根州安阿伯市密歇根大学消化内科和肝病学系。

抽象
背景和目的：

慢性乙型肝炎患者的管理在现实世界中并未得到很好的表征。我们比较了恩替卡韦CHB患者的基线特征，治疗监测的频率，以及学术和社区实践之间ETV治疗的有效性。
方法：

在2005年至2013年期间，在美国26个社区和学术实践中，对未接受过治疗的≥18岁的CHB患者进行了回顾性评估，这些患者接受ETV治疗≥12个月。
结果：

在入选的841名患者中，658名（65％为男性，83％为亚洲人，中位年龄47岁，9％患有肝硬化）符合入选标准。一半的患者（52％）来自社区实践。社区实践中较低比例的患者患有肝硬化或肝癌（5％对14％）。社区实践更常治疗基线ALT <2×ULN的患者。在4年的中位随访期间，与学术实践相比，社区实践更有可能以较少的实验室监测中断ETV。社区实践中接受治疗的患者ALT正常化的5年累积概率更高（70％vs 50％，p <0.001），但HBV DNA检测不到的5年累积概率较低（45％vs 70％，p <0.001）比在学术实践中处理的那些。
结论：

学术实践中，CHB患者患有更高级的肝病，更常见的是遵循AASLD指南，并且比社区实践更频繁地监测ETV治疗患者。虽然社区实践中的患者不太可能获得不可检测的HBV DNA，并且更有可能实现ALT正常化，但HBeAg丢失和血清转换以及HBsAg丢失的发生率相似。
关键词：

抗病毒治疗;慢性HBV; HBeAg丢失; HBsAg丢失;实践管理

结论：
    30238203
DOI：
    10.1007 / s10620-018-5281-3