Eight-year survival in chronic hepatitis B patients under long-term entecavir or tenofovir therapy is similar to the general population

Papatheodoridis, George V.; Sypsa, Vana; Dalekos, George Ν.; Yurdaydın, Cihan; Boemmel, Florian van; Buti, María; Goulis, John; Calleja, José Luís; Chi, Heng; Manolakopoulos, Spilios; Loglio, Alessandro; Siakavellas, Spyros I.; Gatselis, Nikolaos; Keskın, Onur; Lehretz, Maria; Savvidou, Savvoula; Revilla, Juan de la; Hansen, Bettina E.; Κourikou, Αnastasia; Vlachogiannakos, Jiannis; Galanis, Kostantinos; İdilman, Ramazan; Colombo, Massimo; Esteban, Rafael; Janssen, Harry L.A.; Berg, Thomas; Lampertico, Pietro

doi:10.1016/j.jhep.2018.01.031

Cited by 88 publications

(83 citation statements)

References 35 publications

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“…The 5‐year transplant‐free liver‐related survival in the TDF‐treated cohort was excellent at 98.9%. This finding was supported by a multi‐centre European study of Caucasian CHB patients receiving long‐term TDF or entecavir which reported 97.8% transplant‐free liver‐related survival . The authors concluded that CHB patients receiving long‐term TDF (or entecavir) had excellent overall survival, which is similar to that of the general population, regardless of cirrhosis status.…”

Section: Discussionmentioning

confidence: 76%

“…Recently, a large nationwide Korean cohort study compared the incidence of HCC in CHB patients treated with entecavir vs TDF and found that the TDF group had a significantly lower risk of HCC (hazard ratio [HR] 0.61) . Caucasian CHB patients with cirrhosis who did not develop HCC also had similar 8‐year survival compared to the general population …”

Section: Introductionmentioning

confidence: 99%

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Tenofovir disoproxil fumarate reduces hepatocellular carcinoma, decompensation and death in chronic hepatitis B patients with cirrhosis

Liu

Choi

et al. 2019

Aliment Pharmacol Ther

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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.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Tenofovir disoproxil fumarate reduces hepatocellular carcinoma, decompensation and death in chronic hepatitis B patients with cirrhosis

Liu

Choi

et al. 2019

Aliment Pharmacol Ther

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“…However, the existing chronic HBV cases remain at risk for HCC which is increasing as they are becoming older . As secondary prevention, effective antiviral therapy, usually with a nucleos(t)ide analogue (NA), reduces but does not eliminate the HCC risk in patients with chronic hepatitis B (CHB), which remains the key factor adversely affecting the overall good long‐term survival of CHB patients . Development of HCC in chronic HBV patients has been associated with multiple risk factors, only some of which can be modified by either therapy or behavioural changes (Table ) …”

Section: Introductionmentioning

confidence: 99%

Clinical utility of hepatocellular carcinoma risk scores in chronic hepatitis B

Voulgaris

Papatheodoridi

Lampertico

et al. 2020

Liver International

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Background Several risk scores have been recently developed to predict hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. We systematically assessed the performance of the available HCC risk scores. Methods Literature search was performed to identify all published studies reporting development or external validation of HCC risk scores in CHB patients. Results Until March 2019, 12 scores were developed in untreated Asian and 7 scores in treated Asian (n = 6) or Caucasian (n = 1) patients. All scores provided significant predictions for HCC development in the derivation and validation cohorts of their original studies (c‐statistic: 0.76‐0.95) and usually classified patients into low, medium and high HCC risk groups. Eleven independent studies and three studies developing their own scores have validated externally some scores in Asian (GAG‐HCC:5, CU‐HCC:6, REACH‐B:6, REACH‐Bm:4, LSM‐HCC:3, PAGE‐B:5) or Caucasian/mixed origin patients (GAG‐HCC:4, CU‐HCC:4, REACH‐B:4, PAGE‐B:2). All scores offered acceptable predictability in almost all independent Asian cohorts (c‐statistic: 0.70‐0.86), but only PAGE‐B and recently modified PAGE‐B (mPAGE‐B) offered good predictability in all independent Caucasian and/or Asian cohorts. Negative predictive values for 5‐year HCC prediction were ≤99% (95%‐99%) in most independent cohorts assessing Asian risk scores and 99%‐100% in all independent cohorts (Caucasian/mixed origin:2; Asian:3) assessing PAGE‐B and/or recently mPAGE‐B. Conclusions Direct comparison of the newest HCC risk scores in independent patient cohorts of different origin remains intriguing, although statistical associations may not be directly transferable to clinical practice. PAGE‐B and recently mPAGE‐B score seem to offer persistently high predictability for Caucasian and/or Asian treated patients with low HCC risk who require no surveillance.

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“…The threats of chronic viral hepatitis partially vanished due to the revolution of antiviral treatment options first for hepatitis B and more recently for hepatitis C. Persistent HCV infection can nowadays be cleared with direct acting antiviral agents leading to impressive improvements in the clinical long-term outcome with reduced incidences of hepatic decompensation and hepatocellular carcinoma. Similarly, durable suppression of HBV replication has been shown to prevent disease progression and even to normalise life expectancy unless hepatocellular carcinoma appears 1. Unfortunately, the scenario is completely different for hepatitis D virus (HDV) infection.…”

mentioning

confidence: 99%