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J Hepatol. 2018 Jun;68(6):1129-1136. doi: 10.1016/j.jhep.2018.01.031. Epub 2018 Feb 8.

Eight-year survival in chronic hepatitis B patients under long-term entecavir or tenofovir therapy is similar to the general population.

Author information

1
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece. Electronic address: gepapath@med.uoa.gr.
2
Department of Hygiene, Epidemiology and Medical Statistics, Medical School of National and Kapodistrian University of Athens, Athens, Greece.
3
Department of Internal Medicine, Thessalia University Medical School, Larissa, Greece.
4
Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey.
5
Section of Hepatology, Clinic for Gastroenterology and Rheumatology, University Clinic Leipzig, Leipzig, Germany.
6
Liver Unit, Hospital General Universitario Valle Hebron and Ciberehd, Barcelona, Spain.
7
4th Department of Internal Medicine, Αristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
8
Department of Gastroenterology, Hospital U Puerta de Hierro, IDIPHIM CIBERehd, Madrid, Spain.
9
Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
10
2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Athens, Greece.
11
CRC "AM e A Migliavacca" Center for Liver Disease, Division of Gastrotnerology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
12
Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
13
Hepatology Translational Research Center, Humanitas Clinical and Research Centre, Rozzano, Italy.
14
Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Liver Clinic, Toronto Western and General Hospital, University Health Network, Toronto, ON, Canada.

Abstract

BACKGROUND & AIMS:

The effects of long-term antiviral therapy on survival have not been adequately assessed in chronic hepatitis B (CHB). In this 10-centre, ongoing cohort study, we evaluated the probability of survival and factors affecting survival in Caucasian CHB patients who received long-term entecavir/tenofovir therapy.

METHODS:

We included 1,951 adult Caucasians with CHB, with or without compensated cirrhosis and without hepatocellular carcinoma (HCC) at baseline, who received entecavir/tenofovir for ≥12 months (median, six years). Kaplan-Meier estimates of cumulative survival over time were obtained. Standardized mortality ratios (SMRs) were calculated by comparing death rates with those in the Human Mortality Database.

RESULTS:

The one-, five-, and eight-year cumulative probabilities were 99.7, 95.9, and 94.1% for overall survival, 99.9, 98.3, and 97.4% for liver-related survival, and 99.9, 97.8, and 95.8% for transplantation-free liver-related survival, respectively. Overall mortality was independently associated with older age and HCC development, liver-related mortality was associated with HCC development only, and transplantation-free liver-related mortality was independently associated with HCC development and lower platelet levels at baseline. Baseline cirrhosis was not independently associated with any type of mortality. Compared with the general population, in all CHB patients mortality was not significantly different (SMR 0.82), whereas it was lower in patients without HCC regardless of baseline cirrhosis (SMR 0.58) and was higher in patients who developed HCC (SMR 3.09).

CONCLUSION:

Caucasian patients with CHB and compensated liver disease who receive long-term entecavir/tenofovir therapy have excellent overall and liver-related eight-year survival, which is similar to that of the general population. HCC is the main factor affecting their overall mortality, and is the only factor affecting their liver-related mortality.

LAY SUMMARY:

Caucasian patients with chronic hepatitis B with or without compensated cirrhosis who receive long-term entecavir or tenofovir therapy have excellent overall eight-year survival, which is similar to that of the general population. Hepatocellular carcinoma is the main factor affecting their overall mortality, and is the only factor affecting liver-related mortality in this setting.

KEYWORDS:

Antiviral therapy; Cirrhosis; Hepatitis B; Hepatocellular carcinoma; Liver transplantation

PMID:
29427727
DOI:
10.1016/j.jhep.2018.01.031

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