Population-based study of Entecavir and long-term mortality in chronic hepatitis B–related decompensated liver cirrhosis - 08/11/19
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Highlights |
• | Although the beneficial effects of antiviral therapy on chronic hepatitis B-related decompensated liver cirrhosis was established by a previous study, we still need to know the real-world drug efficacy in these patients. This present study is the first nationwide population–based study that enrolled large case numbers of chronic hepatitis B-related decompensated cirrhosis patients. |
• | In chronic hepatitis B-related decompensated cirrhotic patients, higher initial viral loads were correlated with poor outcomes. However, the long-term usage of entecavir can decrease long-term mortality in these patients. |
• | The significant efficacy of entecavir improve long-term survival even in decompensated cirrhotic patients with a greater number of cirrhosis-related complications. |
Summary |
Background and aims |
We lack population-based studies that identify the role of entecavir (ETV) in extending long-term survival in chronic hepatitis B (CHB)-related decompensated liver cirrhotic patients. Since 2010, National Health Insurance in Taiwan has covered long-term medical payment for antiviral therapy in CHB-related cirrhotic patients whose HBV DNA is ≥ 2000 IU/mL. We studied the effect of ETV on the mortality of CHB-related decompensated cirrhosis patients compared with patients who did not receive antiviral agents at baseline.
Methods |
From the Taiwan National Health Insurance Database, we collected 758 CHB-related decompensated cirrhosis patients with elevated viral loads (HBV DNA ≥ 2000 IU/mL) using ETV and discharged between January 1, 2010, and December 31, 2013. The comparison group consisted of 1516 selected CHB-related decompensated cirrhotic patients without antiviral therapy at baseline using propensity score matching analysis.
Results |
The 1-, 2-, and 3-year mortality probabilities were 34.7%, 42.5%, and 48.5 % in the ETV group and 21.1%, 37.8% and 51.3 % in the non-ETV group, respectively. Based on a Cox proportional hazards regression model adjusted by patients’ sex, age, and comorbid disorders, the hazard ratios (HR) in the ETV group for 1-year, 1–2-year, and 2–3-year mortalities were 1.22 (95% confidence interval [CI] 1.05–1.43, P = .010), 1.02 (0.86–1.20, P = .866), and 0.59 (0.38–0.90, P = .016), compared with the non-ETV group.
Conclusions |
Even in CHB-related decompensated cirrhotic patients, higher initial viral loads were correlated with poor outcomes. However, the long-term usage of ETV can decrease long-term mortality in these patients.
Le texte complet de cet article est disponible en PDF.Keywords : Decompensated liver chirrhosis, Chronic hepatitis B, Entecavir
Abbreviations : CHB, CI, ETV, EVB, HBsAg, HCV, HE, HR, ICD-9-CM, NHIRD, PSM, RFI
Plan
Vol 43 - N° 6
P. 694-699 - novembre 2019 Retour au numéro
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