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Dig Dis Sci. 2019 Feb;64(2):358-366. doi: 10.1007/s10620-018-5281-3. Epub 2018 Sep 20.

A Comparison Between Community and Academic Practices in the USA in the Management of Chronic Hepatitis B Patients Receiving Entecavir: Results of the ENUMERATE Study.

Author information

1
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University Medical Center, 1200 E. Broad St., 14th Floor, P.O. Box 980341, Richmond, VA, 23298, USA. hannah.lee@vcuhealth.org.
2
Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, OR, USA.
3
Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA.
4
Yale University, New Haven, CT, USA.
5
Division of Gastroenterology and Hepatology, NYU Langone Health, NYU School of Medicine, New York, USA.
6
Digestive Disease Center, University of Chicago, Chicago, IL, USA.
7
San Jose Gastroenterology, San Jose, CA, USA.
8
Albert Einstein College of Medicine, New York, NY, USA.
9
Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
10
Asian Health Foundation, Rochester, MN, USA.
11
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.

Abstract

BACKGROUND AND AIMS:

The management of chronic hepatitis B patients is not well characterized in real-world practice. We compared baseline characteristics of CHB patients on entecavir, the frequency of on-treatment monitoring, and the effectiveness of ETV treatment between academic and community practices.

METHODS:

Treatment-naïve CHB patients ≥18 years old, treated with ETV for ≥12 months from 2005 to 2013, in 26 community and academic practices throughout the USA were retrospectively evaluated.

RESULTS:

Of 841 patients enrolled, 658 (65% male, 83% Asian, median age 47, 9% with cirrhosis) met inclusion criteria. Half of the patients (52%) were from community practices. A lower percentage of patients in community practices had cirrhosis or liver cancer (5 vs. 14%). Community practices more often treated patients with baseline ALT < 2 × ULN. Over a median follow-up of 4 years, community practices were more likely to discontinue ETV with less frequent laboratory monitoring compared to academic practices. The 5-year cumulative probability of ALT normalization was greater among patients treated in community practices (70 vs. 50%, p < 0.001), but the 5-year cumulative probability of undetectable HBV DNA was lower (45 vs. 70%, p < 0.001) than those treated in academic practices.

CONCLUSION:

Academic practices saw CHB patients with more advanced liver disease, more often followed AASLD guidelines, and monitored patients on ETV treatment more frequently than community practices. While patients in community practices were less likely to achieve undetectable HBV DNA and more likely to achieve ALT normalization, the rates of HBeAg loss and seroconversion as well as HBsAg loss were similar.

KEYWORDS:

Antiviral therapy; Chronic HBV; HBeAg loss; HBsAg loss; Practice management

PMID:
30238203
DOI:
10.1007/s10620-018-5281-3
[Indexed for MEDLINE]

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