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Hepatology. 2015 Jun;61(6):1809-20. doi: 10.1002/hep.27723. Epub 2015 Mar 18.

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

Jang JW1,2, Choi JY1,2, Kim YS3,2, Woo HY4,2, Choi SK5,2, Lee CH6,2, Kim TY7,2, Sohn JH7,2, Tak WY8,2, Han KH9,2.

Author information

1
Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea.
2
Liver Cirrhosis Clinical Research Center, Seoul, Korea.
3
Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
4
Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
5
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
6
Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.
7
Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
8
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
9
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

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.

PMID:
25627342
DOI:
10.1002/hep.27723
[Indexed for MEDLINE]

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