替诺福韦地索普西富马酸盐减少慢性乙型肝炎肝硬化患者的

StephenW

Tenofovir disoproxil fumarate reduces hepatocellular carcinoma, decompensation and death in chronic hepatitis B patients with cirrhosis
Ken Liu
Jonggi Choi
An Le
Terry Cheuk‐Fung Yip
Vincent Wai‐Sun Wong
Stephen Lam Chan
Henry Lik‐Yuen Chan
Mindie H. Nguyen
Young‐Suk Lim
Grace Lai‐Hung Wong
First published: 16 September 2019
https://doi.org/10.1111/apt.15499
Ken Liu, Jonggi Choi and An Le should be considered as joint first author.
Mindie H. Nguyen, Young‐Suk Lim, Grace Lai‐Hung Wong should be considered as joint senior author.
The Handling Editor for this article was Professor Geoffrey Dusheiko, and it was accepted for publication after full peer‐review.

Funding information:

This work was supported by the Investigator Sponsored Research of Gilead Sciences (Reference: IN‐US‐174‐3889).
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Summary
Background

Lamivudine and entecavir reduce hepatic events and death in chronic hepatitis B (CHB) patients with cirrhosis, but the impact of tenofovir disoproxil fumarate (TDF) is less well studied.
Aim

To investigate the effectiveness of TDF therapy in CHB patients with cirrhosis.
Methods

We studied TDF‐treated and untreated CHB patients with cirrhosis from three tertiary centres. TDF cohort included consecutive patients who received TDF for ≥12 months while the untreated cohort were historical controls receiving routine clinical care prior to the availability of anti‐viral therapy. The primary outcome was 5‐year cumulative probability of hepatocellular carcinoma (HCC) with secondary outcomes being hepatic decompensation and death or liver transplantation (LT).
Results

A total of 1088 (291 untreated and 797 TDF‐treated) patients were included in the study. Five‐year cumulative probabilities in untreated vs TDF‐treated cohorts were 14.9% vs 9.8% for HCC (P = .07), 22.3% vs 5.9% for decompensation (P < .01) and 13.1% vs 1.1% for death or LT (P < .01) respectively. On multivariable Cox regression, TDF treatment was independently associated with reduced risks of HCC (adjusted hazard ratio [aHR] 0.46, P < .01), decompensating events (aHR 0.28, P = .01) and death or LT (aHR 0.06, P < .01). On sensitivity analyses, these risk reductions with TDF treatment were consistently demonstrated regardless of severity of liver disease and prior anti‐viral treatment. TDF treatment led to sustained improvements in most validated prognostic scores for predicting HCC, decompensation and death.
Conclusions

Compared to untreated patients, TDF treatment reduces the risks of HCC, hepatic decompensation and death in CHB patients with cirrhosis at 5 years.

StephenW

替诺福韦地索普西富马酸盐减少慢性乙型肝炎肝硬化患者的肝细胞癌，失代偿和死亡
刘Ken
Jonggi Choi
安乐
Terry Cheuk-Fung Yip
Vincent Wai-Sun Wong
Stephen Lam Chan
Henry Lik-Yuen Chan
Mindie H. Nguyen
Young-Suk Lim
Grace Lai-Hung Wong
首次发表：2019年9月16日
https://doi.org/10.1111/apt.15499
Ken Liu，Jonggi Choi和An Le应被视为第一作者。
Mindie H. Nguyen，Young-Suk Lim，Grace Lai-Hung Wong应被视为联合资深作者。
本文的处理编辑器是Geoffrey Dusheiko教授，经过全面的同行评审后被接受发表。

资金信息：

这项工作得到了吉利德科学研究者赞助研究的支持（参考文献：IN-US-174-3889）。
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摘要
背景

拉米夫定和恩替卡韦可减轻慢性乙型肝炎（CHB）肝硬化患者的肝脏事件和死亡，但替诺福韦地索普西富马酸盐（TDF）的影响研究较少。
目标

调查TDF治疗对CHB肝硬化患者的疗效。
方法

我们从三个三级中心研究了TDF治疗和未治疗的肝硬化CHB患者。 TDF队列包括接受TDF≥12个月的连续患者，而未治疗的队列是在抗病毒治疗可用之前接受常规临床护理的历史对照。主要结果是肝细胞癌（HCC）的5年累积概率，其次要结果是肝功能失代偿和死亡或肝移植（LT）。
结果

该研究共纳入1088名患者（291名未治疗患者和797名TDF治疗患者）。未治疗组和TDF治疗组的五年累积概率分别为14.9％和9.8％（P = .07），22.3％对比失代偿为5.9％（P <.01）和13.1％对比死亡或LT为1.1％ （P <.01）。在多变量Cox回归分析中，TDF治疗与HCC风险降低（校正风险比[aHR] 0.46，P <.01），失代偿事件（aHR 0.28，P = .01）和死亡或LT（aHR 0.06，P）独立相关。 <.01）。在敏感性分析中，无论肝病的严重程度和先前的抗病毒治疗如何，都可以始终证明TDF治疗的这些风险降低。 TDF治疗导致大多数经过验证的预后评分持续改善，用于预测HCC，失代偿和死亡。
结论

与未治疗的患者相比，TDF治疗可降低5年肝硬化CHB患者发生HCC，肝功能失代偿和死亡的风险。

StephenW

https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15499?af=R