Long-Term Nucleos(t)ide Analogues Therapy for Adults With Chronic Hepatitis B reduces the Risk of Long-Term Complications: a meta-analysis

Zhang, Qinqin; An, Xuan; Liu, Ying‐Hong; Li, Shi-Ying; Qing, Zhong; Wang, Jing; Hu, Huaidong; Zhang, Dazhi; Ren, Hong; Hu, Peng

doi:10.1186/1743-422x-8-72

Cited by 56 publications

(51 citation statements)

References 37 publications

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“…These data strongly suggested that ETV monotherapy and combinations of NUCs are superior to LAM, ADV, or LDT monotherapy. A greater effect was observed in patients who achieved sustained virological response, while the benefit in nonresponders is unclear (Zhang et al, 2011;Papatheodoridis et al, 2010;Ohishi and Chayama, 2012). In our study, we found that antiviral treatment by both monotherapy and combinations of NUC significantly improved liver function.…”

Section: Et Al 2269supporting

confidence: 57%

“…In patients already infected with HBV, antiviral therapy remains the best strategy to prevent liver cirrhosis and HCC (Lim et al, 2009;Chan et al, 2012;Kwon and Lok, 2011;Kim et al, 2011). Major progress in the treatment of chronic hepatitis B has recently been made during the last decade with the development of antiviral drugs, especially nucleos(t)ide analogs (NUCs) (Fung et al, 2011;Liaw et al, 2011;Zhang et al, 2011). Some data supporting the benefit of antiviral therapy on the prevention of HCC in chronic hepatitis B patients has been shown in a few randomized controlled trials (Zhang et al, 2011;Jin et al, 2011;Lim et al, 2011;Tujios and Lee, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Major progress in the treatment of chronic hepatitis B has recently been made during the last decade with the development of antiviral drugs, especially nucleos(t)ide analogs (NUCs) (Fung et al, 2011;Liaw et al, 2011;Zhang et al, 2011). Some data supporting the benefit of antiviral therapy on the prevention of HCC in chronic hepatitis B patients has been shown in a few randomized controlled trials (Zhang et al, 2011;Jin et al, 2011;Lim et al, 2011;Tujios and Lee, 2012). Nonetheless, antiviral drug resistance is important in determining the success of long-term therapy for chronic hepatitis B patients (Yeh et al, 2011;Papatheodoridis et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Monotherapy versus combinations of nucleos(t)ide in treatment-naive hepatitis B decompensated cirrhotic patients: A nested case-control study

Li#¹

2013

Afr. J. Pharm. Pharmacol.

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The data are limited on the long-term clincial outcome of monotherapy versus combinations of nucleos(t)ide analog (NUCs) for hepatitis B related decompensated cirrhotic patients. This study was to evaluate the efficacy in treatment-naive patients using NUCs monotherapy or combinations. Three hundred and six patients with decompensated hepatitis B cirrhosis were selected from cirrhosis cohort and divided into treatment-naive (n = 260) and control groups (n = 46). Antiviral therapies included monotherapy of lamivudine (LAM, n = 39), adefovir (ADV, n = 73), telbivudine (LDT, n = 36), entecavir (ETV, n = 48), and combinations of LAM+ADV (n = 39) or LDT+ADV (n = 25). Of these patients, 193 in antiviral therapy and 39 in control group were included for analysis over two years. The cumulative drug-resistance rate at two year was higher in the LAM (37.9%), ADV (21.2%), LDT (23.3%) than in the ETV monotherapy (2.6%), and with combinations of LAM+ADV (8.7%) or LDT+ADV (6.3%), respectively, P < 0.001. Serum hepatitis B virus (HBV) DNA undetectability in the ETV and the LDT+ADV group was higher than in the LAM, ADV and LAM+ADV group at over two years (P < 0.05). The child-pugh score (CPs) in the antiviral therapy group was decreased at two years (P < 0.05). In the control group and drug-resistant patients, however, CPs was increased. The two years cumulative incidence of liver failure in the antiviral therapy group was significantly less than the control group (OR 24.9, 95%; CI 6.5 to 94.7, P = 0.001). The total cumulative survival rate in the antiviral therapy group was higher than in control group (OR 4.2, 95%; CI 1.4 to 12.9, P = 0.017). The combinations of NUCs therapy and ETV momotherapy are optimum management for hepatitis B related decompensated cirrhotic patients.

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Section: Et Al 2269supporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Monotherapy versus combinations of nucleos(t)ide in treatment-naive hepatitis B decompensated cirrhotic patients: A nested case-control study

Li#¹

2013

Afr. J. Pharm. Pharmacol.

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“…Some studies have shown that ETV has low incidence of HCC but these studies did not have a control arm 9. A meta‐analysis and a systematic review showed that NAs can reduce liver complications, including HCC 26, 27. Other studies have begun to show that control of sustained viral loads through drugs such as NAs is important in preventing long‐term complications.…”

Section: Discussionmentioning

confidence: 99%

Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection

et al. 2013

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Chronic hepatitis B virus (HBV) infection leads to cirrhosis and hepatocellular carcinoma (HCC). Antiviral agents are thought to reduce HCC development, but agents such as lamivudine (LAM) have a high rate of drug resistance. We compared the incidence of HCC in 472 entecavir (ETV)-treated patients and 1,143 nontreated HBV patients (control group). Propensity score matching eliminated the baseline differences, resulting in a sample size of 316 patients per cohort. The drug mutation resistance was 0.8% (4/472) in the ETV group. The cumulative HCC incidence rates at 5 years were 3.7% and 13.7% for the ETV and control groups, respectively (P < 0.001). Cox proportional hazard regression analysis, adjusted for a number of known HCC risk factors, showed that patients in the ETV group were less likely to develop HCC than those in the control group (hazard ratio: 0.37; 95% confidence interval: 0.15-0.91; P 5 0.030). Both cohorts were applied in three previously reported risk scales and risk scores were generated based on age, gender, cirrhosis status, levels of alanine aminotransferase, hepatitis B e antigen, baseline HBV DNA, albumin, and bilirubin. The greatest HCC risk reduction occurred in high-risk patients who scored higher on respective risk scales. In sub analyses, we compared treatment effect between nucleos(t)ide analogs, which included matched LAM-treated patients without rescue therapy (n 5 182). We found HCC suppression effect greater in ETV-treated (P < 0.001) than nonrescued LAM-treated (P 5 0.019) cirrhosis patients when they were compared with the control group. Conclusion: Long-term ETV treatment may reduce the incidence of HCC in HBV-infected patients. The treatment effect was greater in patients at higher risk of HCC. (HEPATOLOGY 2013;58:98-107) See Editorial on Page 18 M ore than 2 billion people worldwide have been exposed to hepatitis B virus (HBV) and about 350 million people are chronically infected, the majority of whom are in Asia (75%). The prevalence of HBV in Japan is 0.8%, which is lower than other Asian countries such as Taiwan (>10%) and China.1-3 As chronic HBV infection leads to cirrhosis and hepatocellular carcinoma (HCC), published studies have shown that up to 25% of chronically infected patients eventually die of liver cirrhosis or HCC. 4A large-scale longitudinal epidemiologic study has shown that a patient's baseline HBV DNA level is an independent predictor for the development of HCC. 5Studies have begun to show that treatment to decrease HBV DNA reduces the risk of HCC development in HBV patients with cirrhosis or advanced fibrosis or in chronic HBV patients. 6,7 Within the past 10 years, new antiviral therapies, including nucleos(t)ide analogs (NAs), have been approved and were successful in suppressing circulating serum viral loads. Studies that have examined the relationship between NA therapy and HCC almost exclusively used older drugs such as lamivudine and/or adefovir. Although results of long-term studies showed the importance of antiviral suppression, HCC risk among p...

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“…Long-term viral suppression was found to be associated with histologic improvement in the reduction of fibrosis and ultimately regression of cirrhosis [13]. Furthermore, a study has demonstrated that adult patients with CHB need over 2 years of NUC treatment to reduce risk of cirrhosis, HCC or CHB-related death [14]. In order to achieve and maintain virologic suppression, avoid virologic breakthrough, and attain undetectable levels of HBV DNA, optimal medication adherence is essential [15].…”

Section: Introductionmentioning

confidence: 99%

Adherence and perceived barriers to oral antiviral therapy for chronic hepatitis B

Liu

Farazi

et al. 2018

Global Health Action

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Background: Globally, of the 248 million people chronically infected with the hepatitis B virus (HBV), 74 million reside in China. Five oral nucleot(s)ide analogs (NUCs) have been approved for the treatment of chronic hepatitis B (CHB) in China. Objectives: The aims of this study were to determine rates of adherence to NUC therapy in patients with CHB, to identify the self-perceived barriers to adherence, and to examine the factors associated with adherence. Methods: Questionnaire-based interviews were administered among Chinese patients with CHB at hepatology clinics of a tertiary hospital in the city of Wuhan, China. Adults aged 18 years or older prescribed with NUCs were recruited and interviewed to complete a 27-item questionnaire in a private setting, and adherence was measured using the Morisky Medication Adherence Scale (MMAS-8). Results: Among 369 participants, only 16.5% had high adherence (score of 8), 32.2% had medium adherence (score of 6 to <8), and 51.2% were measured with low adherence (score of <6). A logistic regression model was used to determine the factors associated with medication adherence. Significant predictors of high adherence consisted of urban residency, non-cirrhotic status, not using prescribed pills other than HBV medications, and reminders from family members. The five most common reasons for skipping NUCs were that medication(s) are expensive (48.7%), forgetfulness (45.1%), have experienced or worry about potential side effects (19.8%), do not want others to know about my medication(s) usage (18.5%), and ran out of pills and do not have time to refill (15.9%). Conclusions: This study revealed that adherence rates to oral antiviral therapy were far from optimal. This finding should generate public attention, and it would be beneficial for interventional programs to target Chinese patients from rural regions, as well as patients with low socioeconomic status, cirrhosis, and taking multiple medications.

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Long-Term Nucleos(t)ide Analogues Therapy for Adults With Chronic Hepatitis B reduces the Risk of Long-Term Complications: a meta-analysis

Cited by 56 publications

References 37 publications

Monotherapy versus combinations of nucleos(t)ide in treatment-naive hepatitis B decompensated cirrhotic patients: A nested case-control study

Monotherapy versus combinations of nucleos(t)ide in treatment-naive hepatitis B decompensated cirrhotic patients: A nested case-control study

Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection

Adherence and perceived barriers to oral antiviral therapy for chronic hepatitis B

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