Entecavir treatment for up to 5 years in patients with hepatitis B e antigen-positive chronic hepatitis B

Chang, Ting Tsung; Lai, Ching Lung; Yoon, Seung Kew; Lee, Samuel S.; Coelho, Henrique Sérgio Moraes; Carrilho, Flair José; Poordad, Fred; Halota, Waldemar; Horsmans, Yves; Tsai, Naoky; Zhang, Hui; Tenney, Daniel J.; Tamez, Ricardo; Iloeje, Uchenna H.

doi:10.1002/hep.23327

Cited by 539 publications

(480 citation statements)

References 21 publications

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“…Recent liver society guidelines recommended the use of entecavir or tenofovir as first-line therapy in patients with chronic hepatitis B and an indication for nucleoside/nucleotide analogues, because both drugs potently inhibit the HBV reverse transcriptase and have a high barrier to resistance. Entecavir and tenofovir have been shown to efficiently maintain suppression of HBV DNA levels for prolonged periods of time in the vast majority of treated patients [17][18][19]. As a result, most patients who started therapy with other drugs currently receive entecavir and/or tenofovir as part of their treatment regimen in areas where these drugs are available and reimbursed.…”

Section: Discussionmentioning

confidence: 99%

Long-term hepatitis B surface antigen (HBsAg) kinetics during nucleoside/nucleotide analogue therapy: Finite treatment duration unlikely

Chevaliez

Hézode

Bahrami

et al. 2013

Journal of Hepatology

220

173

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Section: Discussionmentioning

confidence: 99%

Long-term hepatitis B surface antigen (HBsAg) kinetics during nucleoside/nucleotide analogue therapy: Finite treatment duration unlikely

Chevaliez

Hézode

Bahrami

et al. 2013

Journal of Hepatology

220

173

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“…Received August 10, 2012; accepted January 15, 2013. risk of drug resistance in long-term studies. 14,15 Histological improvement was observed in 66 of the 69 patients (96%) who had received entecavir for 3 to 7 years. 16 In a randomized trial of 191 patients with decompensated cirrhosis, entecavir-treated patients tended to have lower incidence of HCC than those treated with adefovir at 48 weeks.…”

mentioning

confidence: 97%

Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients With liver cirrhosis

et al. 2013

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Entecavir is a potent antiviral agent with high genetic barrier to resistance, hence it is currently recommended as first-line antiviral therapy for chronic hepatitis B (CHB). The aim of this study was to investigate the efficacy of entecavir on clinical outcomes and deaths. It was a retrospective-prospective cohort study based on two cohorts of patients. The entecavir cohort included consecutive CHB patients who had received entecavir 0.5 mg/day for at least 12 months. The historical control cohort included untreated patients recruited since 1997 who underwent routine clinical care. The primary outcome was the 5-year cumulative probability of hepatic events, defined as any cirrhotic complications, hepatocellular carcinoma (HCC), and/or liver-related mortality. A total of 1,446 entecavir-treated patients (72% men; age, 51 6 12 years; follow-up, 36 6 13 months) and 424 treatment-naïve patients (65% men; age, 41 6 13 years; follow-up, 114 6 31 months) were studied. Overall, there was no difference in hepatic events between the entecavir and control cohorts. Among patients with liver cirrhosis (482 entecavir-treated, 69 treatment-naïve), entecavir-treated patients had reduced risks of all clinical outcomes when compared with treatment-naïve patients with cirrhosis after adjusted for model for end-stage liver disease score: hepatic events (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.34-0.78; P 5 0.002), HCC (HR, 0.55; 95% CI, 0.31-0.99; P 5 0.049), liver-related mortality (HR, 0.26; 95% CI, 0.13-0.55; P < 0.001), and all-cause mortality (HR, 0.34; 95% CI, 0.18-0.62; P < 0.001). Entecavir-treated patients with cirrhosis who failed to achieve undetectable hepatitis B virus DNA (105/482 [22%]) had comparable risk of hepatic events as the untreated patients. Conclusion: Entecavir therapy reduces the risks of hepatic events, HCC, liver-related and all-cause mortality of CHB patients with liver cirrhosis in 5 years, particularly among those who had maintained viral suppression. (HEPATOLOGY 2013;58:1537-1547 C hronic hepatitis B (CHB) is the leading cause of liver cirrhosis and hepatic events, including various cirrhotic complications and hepatocellular carcinoma (HCC) in Asia. 1 A high level of hepatitis B virus (HBV) DNA has been consistently shown to be an independent risk factor for the development of cirrhosis and HCC. 2,3 Antiviral therapy is effective in suppressing HBV DNA and reducing the risk of hepatic events and HCC. 4,5 Lamivudine, the first generation oral nucleoside analogue was shown to reduce the incidence of hepatic events in patients with advanced fibrosis or compensated cirrhosis by 50%. 6 However, the clinical benefit may be negated by lamivudine resistance and virologic relapse after cessation of treatment. 6,7 Therefore, lamivudine is no longer the firstline antiviral therapy for CHB. Instead, nucleos(t)ide analogues with high genetic barrier to resistancenamely, entecavir and tenofovir disoproxil fumarateare recommended by international guidelines. [8][9][10] Entecavir is a more potent ...

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“…By sustained suppression of HBV DNA, achieving HBeAg and/or HBsAg SC, other studies have shown a reduction in fibrosis, as well as regression in cirrhosis (10,13,14). Along with this improved liver histology, it is logical to explain the improved liver function described above.…”

Section: Discussionmentioning

confidence: 95%

Does hepatitis B seroconversion affect survival outcome in patients with hepatitis B related hepatocellular carcinoma?

Yip

Cheung

Poon

et al. 2016

Transl. Gastroenterol. Hepatol.

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Background: Little is known about whether hepatitis B surface antigen (HBsAg) seroconversion (SC) contributes to any survival benefits for patients with hepatocellular carcinoma (HCC).Methods: All patients with hepatitis B-related HCC and HBsAg seroclearance between 1989 and 2013 were identified. Case-and control-groups were matched according to their stage of disease and mode of treatment. Baseline demographics, liver function, and overall survivals (OS) were compared between these two groups.Results: Thirty-nine HCC cases with HBsAg SC were identified, and 312 non-seroconversion (NSC) HCC cases were matched. Forty-eight percent of patients had curative resections, 14% were treated with ablation and 38% were for palliation. Age of patients in SC group was older than those in NSC group (P=0.026). Although there was significantly better liver function in SC vs. NSC groups in terms of bilirubin (P=0.027), albumin (P=0.003), AST (P=0.001) and ALT (P<0.001), there was no overall difference in ChildPugh grade among the two groups. In regarding tumour pathology, SC commonly presented with solitary tumour nodule as compared to multiple nodules in NSC (P=0.027), and was also frequently associated with a normal background liver parenchyma (P<0.001). Although no survival benefit was confirmed in log-rank analysis between SC and NSC, the absolute 5-year survival of SC group was better in resection (72.2% vs.55.3%), ablation (83.3% vs. 57.4%) and palliation (24.4% vs. 14.4%).Conclusions: HCC patients with HBsAg SC are associated with a better background liver parenchyma and function, and might contribute to an improved long-term survival.

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Entecavir treatment for up to 5 years in patients with hepatitis B e antigen-positive chronic hepatitis B

Cited by 539 publications

References 21 publications

Long-term hepatitis B surface antigen (HBsAg) kinetics during nucleoside/nucleotide analogue therapy: Finite treatment duration unlikely

Long-term hepatitis B surface antigen (HBsAg) kinetics during nucleoside/nucleotide analogue therapy: Finite treatment duration unlikely

Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients With liver cirrhosis

Does hepatitis B seroconversion affect survival outcome in patients with hepatitis B related hepatocellular carcinoma?

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