Treatment of Hepatitis B in Decompensated Liver Cirrhosis

Guan, R; Lui, Hock Foong

doi:10.4061/2011/918017

Cited by 38 publications

(35 citation statements)

References 78 publications

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“…In patients with decompensated cirrhosis who are ineligible for liver transplantation, optimal medication management is important to reduce and manage decompensation events and reduce or delay unplanned hospital admissions. Pharmacotherapy for specific disease etiologies, such as chronic hepatitis B or C, may also lead to improvement in liver function and survival . However, medication‐related problems (MRPs), such as nonadherence, mismanagement related to poor patient understanding, and suboptimal monitoring, have been linked with early hospital readmission and substantial resource burden in this group .…”

Section: Mrp Categories and Subtypes Adapted From Hepler And Strandmentioning

confidence: 99%

Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

et al. 2019

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People with decompensated cirrhosis are often prescribed a complex regimen of therapeutic and prophylactic medications. In other chronic diseases, polypharmacy increases the risk of medication misadventure and medication‐related problems (MRPs), with associated increased morbidity, mortality, and health care costs. This study examined MRPs in a cohort of ambulatory patients with a history of decompensated cirrhosis who were enrolled in a randomized controlled trial of a pharmacist‐led, patient‐oriented medication education intervention and assessed the association between MRPs and patient outcomes. A total of 375 MRPs were identified among 57 intervention patients (median, 6.0; interquartile range, 3.5‐8.0 per patient; maximum 17). Nonadherence (31.5%) and indication issues (29.1%) were the most prevalent MRP types. The risk of potential harm associated with MRPs was low in 18.9% of instances, medium in 33.1%, and high in 48.0%, as categorized by a clinician panel using a risk matrix tool. Patients had a greater incidence rate of high‐risk MRPs if they had a higher Child‐Pugh score (incidence rate ratio [IRR], 1.31; 95% confidence interval [CI], 1.09‐1.56); greater comorbidity burden (IRR, 1.15; 95% CI, 1.02‐1.29); and were taking more medications (IRR, 1.12; 95% CI, 1.04‐1.22). A total of 221 MRPs (58.9%) were resolved following pharmacist intervention. A greater proportion of high‐risk MRPs were resolved compared to those of low and medium risk (68.9% versus 49.7%; P < 0.001). During the 12‐month follow‐up period, intervention patients had a lower incidence rate of unplanned admissions compared to usual care (IRR, 0.52; 95% CI, 0.30‐0.92). Conclusion : High‐risk MRPs are prevalent among adults with decompensated cirrhosis. Pharmacist intervention facilitated identification and resolution of high‐risk MRPs and was associated with reduced incidence rate of unplanned hospital admissions in this group.

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Section: Mrp Categories and Subtypes Adapted From Hepler And Strandmentioning

confidence: 99%

Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

et al. 2019

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“…Hepatit B virusu (HBV)'na bağlı kompanse sirozlu hastalarda sepsis ve dekompansasyon riski nedeniyle interferon (IFN) tedavisi yeğlenmez; verilecekse de yakın izlem altında verilmelidir (1). Oral antiviraller olarak ilk seçenekler yüksek potensli ilaçlar olan entekavir (ETV) ve tenofovir (TDF)'dir.…”

Section: Kompanse Ve Dekompanse Sirozlu Hastalarda Kronik Hepatit B Tunclassified

“…Dekompanse sirozu olan KHB hastalarında ölümlerin çoğunun tedavinin ilk 6 ayında meydana geldiği ve tedavi öncesindeki bilirübin, kreatinin ve HBV DNA düzeylerinin artmış olmasının yüksek risk faktörleri olduğu saptanmış-tır. HBV replikasyonunun erken baskılanmasıyla olumlu sonuçlar alınması mümkündür (5 aşamada uygulanır: [1] Karaciğer nakli süresince, anhepatik fazda, intravenöz (İV) olarak 4000-10000 İÜ; [2] nakil sonrası 3-7 gün süresince, intramüsküler (İM) veya İV 2000-10000 İÜ/gün; [3] nakli izleyerek anti-HBs düzeyi 100 İÜ/lt üzerinde tutulacak şekilde yüksek doz (10000 İÜ/ay) ya da düşük doz (400-2000 İÜ/14 gün veya 3000-6000 İÜ/ay veya 10000 İÜ/2-3 ay) verilir (6,8). İdame dozu ya seçilen sabit bir miktarda uygulanır ya da çoğu merkezde yeğlendiği gibi alıcının anti-HBs düzeyi izlenerek belirlenir.…”

Section: Kompanse Ve Dekompanse Sirozlu Hastalarda Kronik Hepatit B Tunclassified

Management of Chronic Hepatitis in Special Hosts and Special Situations: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

Mıstık¹,

Aydın²,

Aksoy³

et al. 2015

Klimik Dergisi

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ÖzetTürk Klinik Mikrobiyoloji ve İnfeksiyon Hastalıkları Derneği Viral Hepatit Çalışma Grubu, özel konaklarda ve özel durumlarda kronik hepatit yönetimine ilişkin bir uzlaşı raporu hazırlamak üzere bir toplantı düzenlemiştir. Raporda konuyla ilgili literatür ve uluslararası kılavuzlar, hepatit B virusu (HBV) için sırasıyla kompanse ve dekompanse sirozlu hastalarda kronik hepatit B (KHB) tedavisi, karaciğer nakli sonrası HBV infeksiyonunun nüks etmesinden korunma ve nüks gelişen hastalarda tedavi, fülminan hepatit B tedavisi, hemodiyaliz hastalarında KHB teda- AbstractStudy Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases convened a meeting to develop a consensus report on management of chronic hepatitis in special hosts and special situations. Relevant literature and international guidelines were reviewed, and recommendations agreed are presented at the end of each section such as therapy of chronic hepatitis B (CHB) in patients with compensated and decompensated cirrhosis, prevention and therapy of recurrent hepatitis B after liver transplantation, management of fulminant

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“…Decompensated HBV patients receiving oral NAs must be monitored frequently (every 3 months) for virological and clinical response, the patients’ compliance, drug resistance and adverse effects . Renal function and lactic acidosis should be monitored in these patients, especially in those with a model for end‐stage liver disease (MELD) score > 20 .…”

Section: Monitoringmentioning

confidence: 99%

“…2,7 MONITORING Decompensated HBV patients receiving oral NAs must be monitored frequently (every 3 months) for virological and clinical response, the patients' compliance, drug resistance and adverse effects. 10 Renal function and lactic acidosis should be monitored in these patients, especially in those with a model for end-stage liver disease (MELD) score > 20. 2 One systematic review 11 has shown that among patients receiving antiviral therapy, cirrhosis, HBeAg-negative at baseline and failure to remain in virological remission were associated with an increased risk of HCC.…”

Section: Selection Of Antiviral Therapymentioning

confidence: 99%

Antiviral therapy for hepatitis B virus‐related decompensated cirrhosis

Wang

2012

J of Digest Diseases

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Antiviral therapy is important in patients with hepatitis B virus (HBV)-related decompensated cirrhosis. This therapy is beneficial in most patients for the stabilization or improvement of liver disease; however, advanced cirrhosis with a high Child-Pugh or model for end-stage liver disease (MELD) score may have progressed and does not benefit from antiviral therapy. It is important to identify patients with severe decompensated cirrhosis who will not improve under antiviral therapy and who require liver transplantation as early as possible. Entecavir (ETV) or tenofovir disoproxil fumarate (TDF) is the first-line therapy for nucleos(t)ide analogue (NA)-naive patients with decompensated cirrhosis due to their potent and prompt HBV suppressive effect and low rate of drug-resistant mutations. Patients on antiviral therapy should be monitored for virological and clinical response, compliance, drug resistance and adverse effects as well as surveillance for hepatocellular carcinoma (HCC). Additional studies of TDF and ETV are necessary to determine the optimal agent(s) for treating naive patients and those with drug-resistant decompensated cirrhosis. In order to evaluate the effectiveness of NA for the treatment of decompensated cirrhotic patients in the real world, high quality observational studies such as registration studies of antiviral therapy for HBV-related cirrhosis and a long-term follow-up in China, where a large number of such patients are found, are recommended.

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Treatment of Hepatitis B in Decompensated Liver Cirrhosis

Cited by 38 publications

References 78 publications

Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

Medication‐Related Problems in Outpatients With Decompensated Cirrhosis: Opportunities for Harm Prevention

Management of Chronic Hepatitis in Special Hosts and Special Situations: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

Antiviral therapy for hepatitis B virus‐related decompensated cirrhosis

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