Predictors of Liver Fibrosis in Patients with Chronic HCV Infection

Ceylan, Bahadır; Yardimci, Ahmet Cem; Fincancı, Muzaffer; Tözalgan, Ümit; Eren, Gülhan; Müderrisoğlu, Cüneyt; İnci, Ayşe

doi:10.5336/medsci.2011-25802

Cited by 14 publications

(21 citation statements)

References 36 publications

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“…These studies reported that the decline in serum HBV DNA levels and HBV DNA negativity rates were not different between TDF and ETV treatments for CHB (26,27). A recent meta-analysis also confirmed that no differences were observed in the ALT normaliza- tion rates and HBeAg seroconversion rates after 24 weeks and 48 weeks of TDF or ETV therapy (28).…”

Section: Discussionsupporting

confidence: 50%

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Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

Hung

et al. 2015

Antimicrob Agents Chemother

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bTenofovir disoproxil fumarate (TDF) and entecavir (ETV) are effective antivirals recommended as first-line monotherapies for treatment of chronic hepatitis B (CHB) infection. This study aimed to compare the short-term efficacies of TDF and ETV in the treatment of CHB with severe acute exacerbation. From 2008 to 2013, 189 consecutive treatment-naive CHB patients receiving TDF (n ‫؍‬ 41) or ETV (n ‫؍‬ 148) for severe acute exacerbation were enrolled. The primary endpoint was overall mortality or receipt of liver transplantation by week 24. The baseline characteristics were comparable between these two groups. By week 24, 8 (19% [95% confidence interval {CI}, 7% to 32%]) patients in the TDF group and 26 (18% [95% CI, 11 to 24%]) patients in the ETV group died (n ‫؍‬ 30) or received liver transplantation (n ‫؍‬ 4) (P ‫؍‬ 0.749). The two groups of patients developed similar rates of liver-related complications and achieved comparable biochemical and virological responses at week 24. Cox regression analysis showed that baseline viral DNA level (P ‫؍‬ 0.002), hypertension (P ‫؍‬ 0.002), model for end-stage liver disease (MELD) score (P ‫؍‬ 0.01), platelet count (P ‫؍‬ 0.005), early presence (within 4 weeks) of ascites (P ‫؍‬ 0.005), hepatic encephalopathy (P ‫؍‬ 0.002), and hepatorenal syndrome (P < 0.001) were independent factors for mortality or liver transplantation. Among the patients who survived by week 24, there was no difference between the two groups in the percentage of patients who had a serum creatinine increase of >0.5 mg/dl from baseline (6.7% [95% CI, 0% to 16%] versus 2.0% [95% CI, 0% to 4.8%] in the TDF and ETV groups, respectively; P ‫؍‬ 0.231), whereas a significant reduction in the estimated glomerular filtration rate (eGFR) was found in the two groups (P ‫؍‬ 0.001 for both). In conclusion, TDF and ETV produce a similar treatment response and clinical outcome in patients with severe acute exacerbation of CHB. C hronic hepatitis B virus (HBV) infection is a major global health issue, affecting around 370 million people worldwide (1). Patients with chronic hepatitis B (CHB) are at a significantly increased risk for the development of liver failure, cirrhosis, and hepatocellular carcinoma (HCC) (2). In its natural course, up to 30% of CHB patients experience a spontaneous reactivation of hepatitis every year (3). Severe acute exacerbation of CHB characterized by high serum alanine aminotransferase (ALT) level, jaundice, and hepatic decompensation leads to a high mortality rate, ranging from 30 to 70% (4, 5). Most guidelines recommend treatment with oral nucleos(t)ide analogues (NUCs) for CHB patients with severe acute exacerbation as soon as possible (6-8). Liver transplantation is the salvage treatment if medical therapy fails; however, this is neither readily available nor feasible in many parts of the world where HBV is highly endemic (5, 9). Lamivudine (LAM) was the first effective oral HBV replication-suppressive agent and has been widely used in patients with severe acute exacerbation of CHB (4,...

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Section: Discussionsupporting

confidence: 50%

“…There are some observational studies comparing TDF and ETV in terms of their antiviral responses to CHB (26,27). These studies reported that the decline in serum HBV DNA levels and HBV DNA negativity rates were not different between TDF and ETV treatments for CHB (26,27).…”

Section: Discussionmentioning

confidence: 99%

Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

Hung

et al. 2015

Antimicrob Agents Chemother

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“…The use of tenofovir and entecavir was compared in 13 studies with average sample sizes of 62 per treatment group (range, 22‐148). The first RCT of HBV‐infected adults with decompensated cirrhosis showed no significant difference in serum creatinine or creatinine clearance over 48 weeks of tenofovir (n = 45) or entecavir (n = 22) . The second RCT of 200 HBV‐infected adults (100 on tenofovir, 100 on entecavir) showed no significant decline in renal function and no difference in adverse events .…”

Section: Renal and Bone Disease In Persons On Na Therapymentioning

confidence: 99%

AASLD guidelines for treatment of chronic hepatitis B

Terrault¹,

Bzowej²,

Chang³

et al. 2015

Hepatology

1,820

2,022

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“…Si bien, se han publicado estudios que comparan directamente ambas opciones de tratamiento (24)(25)(26)(27)(28)(29)(30)(31) existen algunas comparaciones indirectas reportadas en distintos metaanálisis en red, que definen una jerarquía en la eficacia de los agentes antivirales (32)(33)(34) . Para el presente análisis se han considerado los resultados del metaanálisis en red más reciente (18) respecto de las opciones antivirales para HBV crónica, el que comprendió un total 21 pares de comparación con 5073 pacientes näive de tipo HbeAg positivo y 16 pares de comparación con 2604 pacientes näive de tipo HbeAg negativo.…”

Section: Discussionunclassified

Costo-efectividad de dos terapias antivirales para hepatitis B crónica en el Perú: entecavir y tenofovir

Bolaños-Díaz¹,

Tejada

Sanabria

et al. 2017

Rev Peru Med Exp Salud Publica

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Objetivos. Comparar en términos de costo-efectividad a entecavir (ETV) y tenofovir (TDF) en el tratamiento del virus de la hepatitis B (HBV) en hospitales públicos del Perú. Materiales y métodos. Estructuramos un modelo de Markov, definimos la efectividad en años de vida ajustados a calidad (AVAC). Incluimos los costos directos del tratamiento en soles desde la perspectiva del Ministerio de Salud del Perú. Calculamos la relación entre costo y efectividad incrementales (ICER). Realizamos análisis de sensibilidad determinístico y probabilístico, considerando un rango de disponibilidad de pago (WTP) desde uno hasta tres veces el producto bruto interno (PBI) per-cápita, y el beneficio monetario neto (BMN) o ICER en el caso del análisis de tornado. Resultados. El tratamiento con TDF es más efectivo y menos costoso que ETV. El ETV tuvo un costo por AVAC de S/ 4482, y de S/ 1526 para TDF. El TDF mantiene un BMN progresivamente mayor conforme aumenta la WTP. La tasa de descuento fue la única variable con efecto significativo en la incertidumbre del modelo. Conclusiones. El tratamiento con TDF es más costo-efectivo que ETV en hospitales públicos del Perú. Palabras clave: Hepatitis B, antiretrovirales, Economía médica. (fuente: DeCS BIREME). COST-EFFECTIVENESS OF TWO ANTIVIRAL THERAPIES FOR CHRONIC HEPATITIS B IN PERU: ENTECAVIR AND TENOFOVIR ABSTRACTObjetives. To compare in terms of cost-effectiveness to entecavir (ETV) and tenofovir (TDF) in the treatment of hepatitis B virus (HBV) in public hospitals in Peru. Materials and methods. We structured a Markov model. We define effectiveness adjusted life years for quality (QALY). We include the direct costs of treatment in soles from the perspective of the Ministry of Health of Peru. We estimate the relationship between cost and effectiveness ratios (ICER). We performed sensitivity analyzes considering a range of willingness to pay (WTP) from one to three times the Gross Domestic Product (GDP) per capita, and a tornado analysis regarding Monetary Net Profit (BMN) or ICER. Results. Treatment with TDF is more effective and less expensive than ETV. The ETV had a cost per QALY of PEN 4482, and PEN 1526 TDF. The PTO maintains a progressively larger with increasing WTP BMN. The discount rate was the only variable with a significant effect on model uncertainty. Conclusion: Treatment with TDF is more cost-effective than ETV in public hospitals in Peru. INTRODUCCIÓNEl virus de la hepatitis B (HBV) pertenece a la familia Hepadnaviridae (ortohepadnavirus), y puede ocasionar tanto enfermedad aguda como crónica. Existen diez genotipos (A-J) que difieren en un 8%, y múltiples subgenotipos que difieren en un 4%(1,2) . La transmisión es por vía sanguínea, mediante relaciones sexuales, por procedimientos médicos con material o productos contaminados y, en menor medida, por vía transplacentaria (3) .El diagnóstico se realiza mediante la detección del antígeno superficial (HbsAg), en los casos de infección aguda se detectará además inmunoglobulina M (Ig M) contra el antígeno del núcleo (HbcA...

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Predictors of Liver Fibrosis in Patients with Chronic HCV Infection

Cited by 14 publications

References 36 publications

Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

Tenofovir versus Entecavir in Treatment of Chronic Hepatitis B Virus with Severe Acute Exacerbation

AASLD guidelines for treatment of chronic hepatitis B

Costo-efectividad de dos terapias antivirales para hepatitis B crónica en el Perú: entecavir y tenofovir

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