Tenofovir, entecavir, and lamivudine in patients with severe acute exacerbation and hepatic decompensation of chronic hepatitis B. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Park, Jung Gil; Lee, Yu Rim; Park, Soo Young; Lee, Heon Ju; Tak, Won Young; Kweon, Young Oh; Jang, Se Young; Chun, Jae Min; Han, Young Seok; Hur, Keun; Lee, Hye Won; Kang, Min Kyu
• Is Part Of: Digestive and liver disease. Volume 50:Issue 2(2018)
• Page Start: 163
• Page End: 167
• Publication Date: 2018-02
• Subjects: Acute exacerbation -- Chronic hepatitis B -- Entecavir -- Lamivudine -- Tenofovir; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2017.10.002
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Objective: To compare the efficacy of and mortality after lamivudine (LAM), tenofovir (TDF), and entecavir (ETV) treatment in patients with severe acute chronic hepatitis B (CHB) exacerbation. Methods: We analyzed 91 patients with severe acute CHB exacerbation treated with LAM (n = 28), TDF (n = 26), or ETV (n = 37) for 10 years. The primary endpoint was overall mortality or liver transplantation (LT) by 48 weeks. The determined predictors of mortality, virologic and biochemical responses, and drug resistance were also evaluated. Results: The overall mortality or LT rate was not significantly different among the LAM (14.3%), ETV (10.8%), and TDF (3.8%) groups (P = 0.435). In the multivariate analysis, the occurrence of ascites (hazard ratio [HR] 10.467, 95% confidence interval [CI] 1.596–68.645, P = 0.014) and model for end-stage liver disease (MELD) scores above 25 (HR 28.920, CI 4.719-177.251, P = 0.000) increased the risk of mortality or LT. All groups showed similar biochemical responses (P = 0.134), virologic responses (HBV DNA <116 copies/mL, P = 0.151), and HBeAg seroconversion (P = 0.560). Antiviral resistance emerged in five patients treated with LAM by 48 weeks (17.9%, P = 0.003). Conclusion: LAM, ETV, and TDF selection is not related with mortality and LT in patients with severe acute CHB exacerbation and hepatic decompensation. To reduce mortality, patients with ascites and MELD scores above 25 should be considered for LT.