Long‐term effect of antiviral therapy on disease course after decompensation in patients with hepatitis B virus–related cirrhosis

Abstract

The effect of viral suppression on long-term disease outcome after decompensation in patients with hepatitis B virus (HBV)-related cirrhosis has not been established. The aim of this study was to determine the long-term effect of antiviral therapy (AVT) in patients with HBV-related decompensated cirrhosis. This was a multicenter, prospective, inception cohort study of 707 patients who presented with first-onset decompensated complications, including 284 untreated and 423 antiviral-treated patients (58 previously treated, 253 with early treatment, and 112 with delayed treatment). The primary endpoint was 5-year liver transplantation (LT)-free survival. Secondary endpoints included virological response (VR) and serological response and improvement in liver function. Despite baseline high HBV activity and worse liver function, antiviral-treated patients had significantly better transplant-free survival than untreated patients (5-year survival rates of 59.7% vs. 46.0%, respectively), with more apparent benefits from antivirals in Child-Turcotte-Pugh class B/C and high-viremia groups. The rate of VR and hepatitis B e antigen seroconversion at 5 years in antiviral-treated patients was 14.2% and 49.1%, respectively. A significant improvement in liver function was observed in treated versus untreated patients, with 33.9% of treated patients delisted for LT. Patients with early treatment had better clinical outcomes than those with delayed treatment. Survival was dependent on antiviral response, being significantly better in responders than in nonresponders or untreated cases. The initial benefit of AVT was negated over time in nonresponders. Antiviral treatment and maintained VR remained independently predictive of survival. The study results were corroborated by propensity score-matching analysis. Conclusion: AVT significantly modifies the natural history of decompensated cirrhosis, improving liver function and increasing survival. The results underscore the importance of promptly administering potent antiviral drugs to patients under consideration for LT.

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

“…1,57 There is strong evidence that antiviral therapy significantly modifies the natural history of decompensated cirrhosis, improving liver function and increasing survival. 57,58,148 Meta-analyses demonstrated an overall and transplant-free survival in NA treated patients of more than 80%, respectively. 58,59 Approximately 35% of treated patients can be delisted for liver transplantation, and an improvement of Child-Pugh Score P2 observed in at least 40-50%.…”

“…Patients with early treatment initiation had better clinical outcomes than those with delayed treatment. 148 High baseline Child-Pugh or MELD scores are predictors of poor survival meaning that the disease may have progressed beyond the point of no return. 58,[148][149][150] In contrast, an improvement in MELD or Child-Pugh score early on-treatment is highly predictive of transplant-free survival.…”

“…148 High baseline Child-Pugh or MELD scores are predictors of poor survival meaning that the disease may have progressed beyond the point of no return. 58,[148][149][150] In contrast, an improvement in MELD or Child-Pugh score early on-treatment is highly predictive of transplant-free survival. 1,148,149 Undetectable HBV DNA levels can be achieved in [80% after 1 year of treatment, and are associated with a lower risk of HCC development.…”

Direct antiviral agent treatment of decompensated hepatitis C virus-induced liver cirrhosis

“…Although successful treatment outcomes in HCV induced cirrhotics resulted in the significant prevention of HCC [39] , it is not yet clear whether DAA treatment for decompensated HCV-LC lowers the incidence of HCC. Actually, despite clinical improvement, the occurrence of HCC was not significantly suppressed by NA treatment for decompensated HBV-LC [35] . However, given the difference of pathogenesis between HBV and HCV, in that one virus integrates into the genome and the other does not, the two infections might not always respond in a similar fashion.…”

“…Jang et al [35] reported the long-term effect of the NAs in patients with decompensated HBV-LC. They followed 284 untreated patients and 423 treated with NAs for more than 7 years and found that transplant-free survival was significantly improved in those treated with NAs (59.7% vs 46.0%).…”