Prognosis of hepatitis B-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents

Chang Ha Kim, Soon-Ho Um, Yeon Seok Seo, Jin Yong Jung, Jin Dong Kim, Hyung Joon Yim, Bora Keum, Yong Sik Kim, Yoon Tae Jeen, Hong Sik Lee, Hoon-Jai Chun, Chang Duck Kim, Ho Sang Ryu

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Abstract

Background and Aim: We investigated long-term outcomes and prognostic factors in patients with hepatitis B virus (HBV)-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents. Methods: Between January 1999 and February 2009, a total of 240 consecutive patients who had HBV-related cirrhosis without malignancy were treated with lamivudine and second line nucleos(t)ide analogs. The group of historical controls consisted of 481 consecutive patients with HBV-related cirrhosis who were managed without any antiviral treatment prior to 1999. Results: In 78% of the patients who received antiviral treatment, sustained viral suppression (serum HBV DNA <105 copies/mL) was achieved during a mean follow-up period of 46months. The occurrences of death, hepatic decompensation, and hepatocellular carcinoma (HCC) were less frequent in the treated cohort than in untreated historical controls, with the 5-year cumulative incidences being 19.4% versus 43.9% (log-rank P<0.001), 15.4% versus 45.4% (P=0.001), and 13.8% versus 23.4% (P=0.074), respectively. For patients who received antiviral treatment, suboptimal viral suppression (HBV DNA >105 copies/mL at last follow-up) was an important independent risk factor of death (P<0.001) and hepatic decompensation (P=0.019), and was linked to an increased risk of HCC (P=0.042). Although the Child-Pugh grade remained a useful prognostic factor, no significant differences were found between patients with Child-Pugh grade B and C cirrhosis at the beginning of antiviral treatment (P=0.656). Conclusions: Oral antiviral agents have improved the prognosis of patients with HBV-related cirrhosis and affected the prognostic values of factors constituting the Child-Pugh system, necessitating a more efficient prognostic system.

Original languageEnglish
Pages (from-to)1589-1595
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume27
Issue number10
DOIs
Publication statusPublished - 2012 Jan 1

Fingerprint

Hepatitis B
Liver Cirrhosis
Antiviral Agents
Hepatitis B virus
Fibrosis
Lamivudine
Therapeutics
Control Groups
Liver
DNA
Serum
Neoplasms

Keywords

  • Hepatitis B-related liver cirrhosis
  • Lamivudine
  • Oral antiviral agent
  • Prognosis

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{dbba7e87e10b484297ec693216b17e38,
title = "Prognosis of hepatitis B-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents",
abstract = "Background and Aim: We investigated long-term outcomes and prognostic factors in patients with hepatitis B virus (HBV)-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents. Methods: Between January 1999 and February 2009, a total of 240 consecutive patients who had HBV-related cirrhosis without malignancy were treated with lamivudine and second line nucleos(t)ide analogs. The group of historical controls consisted of 481 consecutive patients with HBV-related cirrhosis who were managed without any antiviral treatment prior to 1999. Results: In 78{\%} of the patients who received antiviral treatment, sustained viral suppression (serum HBV DNA <105 copies/mL) was achieved during a mean follow-up period of 46months. The occurrences of death, hepatic decompensation, and hepatocellular carcinoma (HCC) were less frequent in the treated cohort than in untreated historical controls, with the 5-year cumulative incidences being 19.4{\%} versus 43.9{\%} (log-rank P<0.001), 15.4{\%} versus 45.4{\%} (P=0.001), and 13.8{\%} versus 23.4{\%} (P=0.074), respectively. For patients who received antiviral treatment, suboptimal viral suppression (HBV DNA >105 copies/mL at last follow-up) was an important independent risk factor of death (P<0.001) and hepatic decompensation (P=0.019), and was linked to an increased risk of HCC (P=0.042). Although the Child-Pugh grade remained a useful prognostic factor, no significant differences were found between patients with Child-Pugh grade B and C cirrhosis at the beginning of antiviral treatment (P=0.656). Conclusions: Oral antiviral agents have improved the prognosis of patients with HBV-related cirrhosis and affected the prognostic values of factors constituting the Child-Pugh system, necessitating a more efficient prognostic system.",
keywords = "Hepatitis B-related liver cirrhosis, Lamivudine, Oral antiviral agent, Prognosis",
author = "Kim, {Chang Ha} and Soon-Ho Um and Seo, {Yeon Seok} and Jung, {Jin Yong} and Kim, {Jin Dong} and Yim, {Hyung Joon} and Bora Keum and Kim, {Yong Sik} and Jeen, {Yoon Tae} and Lee, {Hong Sik} and Hoon-Jai Chun and Kim, {Chang Duck} and Ryu, {Ho Sang}",
year = "2012",
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doi = "10.1111/j.1440-1746.2012.07167.x",
language = "English",
volume = "27",
pages = "1589--1595",
journal = "Journal of Gastroenterology and Hepatology (Australia)",
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TY - JOUR

T1 - Prognosis of hepatitis B-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents

AU - Kim, Chang Ha

AU - Um, Soon-Ho

AU - Seo, Yeon Seok

AU - Jung, Jin Yong

AU - Kim, Jin Dong

AU - Yim, Hyung Joon

AU - Keum, Bora

AU - Kim, Yong Sik

AU - Jeen, Yoon Tae

AU - Lee, Hong Sik

AU - Chun, Hoon-Jai

AU - Kim, Chang Duck

AU - Ryu, Ho Sang

PY - 2012/1/1

Y1 - 2012/1/1

N2 - Background and Aim: We investigated long-term outcomes and prognostic factors in patients with hepatitis B virus (HBV)-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents. Methods: Between January 1999 and February 2009, a total of 240 consecutive patients who had HBV-related cirrhosis without malignancy were treated with lamivudine and second line nucleos(t)ide analogs. The group of historical controls consisted of 481 consecutive patients with HBV-related cirrhosis who were managed without any antiviral treatment prior to 1999. Results: In 78% of the patients who received antiviral treatment, sustained viral suppression (serum HBV DNA <105 copies/mL) was achieved during a mean follow-up period of 46months. The occurrences of death, hepatic decompensation, and hepatocellular carcinoma (HCC) were less frequent in the treated cohort than in untreated historical controls, with the 5-year cumulative incidences being 19.4% versus 43.9% (log-rank P<0.001), 15.4% versus 45.4% (P=0.001), and 13.8% versus 23.4% (P=0.074), respectively. For patients who received antiviral treatment, suboptimal viral suppression (HBV DNA >105 copies/mL at last follow-up) was an important independent risk factor of death (P<0.001) and hepatic decompensation (P=0.019), and was linked to an increased risk of HCC (P=0.042). Although the Child-Pugh grade remained a useful prognostic factor, no significant differences were found between patients with Child-Pugh grade B and C cirrhosis at the beginning of antiviral treatment (P=0.656). Conclusions: Oral antiviral agents have improved the prognosis of patients with HBV-related cirrhosis and affected the prognostic values of factors constituting the Child-Pugh system, necessitating a more efficient prognostic system.

AB - Background and Aim: We investigated long-term outcomes and prognostic factors in patients with hepatitis B virus (HBV)-related liver cirrhosis in the era of oral nucleos(t)ide analog antiviral agents. Methods: Between January 1999 and February 2009, a total of 240 consecutive patients who had HBV-related cirrhosis without malignancy were treated with lamivudine and second line nucleos(t)ide analogs. The group of historical controls consisted of 481 consecutive patients with HBV-related cirrhosis who were managed without any antiviral treatment prior to 1999. Results: In 78% of the patients who received antiviral treatment, sustained viral suppression (serum HBV DNA <105 copies/mL) was achieved during a mean follow-up period of 46months. The occurrences of death, hepatic decompensation, and hepatocellular carcinoma (HCC) were less frequent in the treated cohort than in untreated historical controls, with the 5-year cumulative incidences being 19.4% versus 43.9% (log-rank P<0.001), 15.4% versus 45.4% (P=0.001), and 13.8% versus 23.4% (P=0.074), respectively. For patients who received antiviral treatment, suboptimal viral suppression (HBV DNA >105 copies/mL at last follow-up) was an important independent risk factor of death (P<0.001) and hepatic decompensation (P=0.019), and was linked to an increased risk of HCC (P=0.042). Although the Child-Pugh grade remained a useful prognostic factor, no significant differences were found between patients with Child-Pugh grade B and C cirrhosis at the beginning of antiviral treatment (P=0.656). Conclusions: Oral antiviral agents have improved the prognosis of patients with HBV-related cirrhosis and affected the prognostic values of factors constituting the Child-Pugh system, necessitating a more efficient prognostic system.

KW - Hepatitis B-related liver cirrhosis

KW - Lamivudine

KW - Oral antiviral agent

KW - Prognosis

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