Limits...
Disease Progression in Chronic Hepatitis B Patients under Long-Term Antiviral Therapy.

Moon JC, Kim SH, Kim IH, Lee CH, Kim SW, Lee SO, Lee ST, Kim DG - Gut Liver (2015)

Bottom Line: This retrospective study included 524 naive CHB patients who received oral NA therapy for more than 48 weeks between January 2003 and December 2007.Similarly, age >50 years (HR, 1.05), family history of HCC (HR, 5.48), and cirrhosis (HR, 17.16) were significant factors for HCC development.Longer duration of maintained virological response significantly reduces the risk of disease progression or HCC development in CHB patients undergoing long-term oral NA therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT

Background/aims: We investigated factors associated with the disease progression and development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients during long-term oral nucleos(t)ide analog (NA) therapy.

Methods: This retrospective study included 524 naive CHB patients who received oral NA therapy for more than 48 weeks between January 2003 and December 2007. The primary outcome was 5-year cumulative probability of disease progression and HCC development. Disease progression was defined as cirrhosis development, cirrhotic complications, HCC or liver-related mortality.

Results: For the 524 patients, the cumulative probabilities of disease progression and HCC development at 1, 2, 3, 4 and 5 years were 1.1%, 6.3%, 9.0%, 11.6%, and 16.2% and 0.2%, 1.8%, 3.6%, 5.8%, and 9.3%, respectively. In multivariate analysis, age >50 years (hazard ratio [HR], 1.05) and cirrhosis (HR, 2.95) were significant factors for disease progression. Similarly, age >50 years (HR, 1.05), family history of HCC (HR, 5.48), and cirrhosis (HR, 17.16) were significant factors for HCC development. Importantly, longer duration (>12 months) of maintained virological response (<20 IU/mL) reduced the risks of disease progression (HR, 0.19) and HCC development (HR, 0.09).

Conclusions: Longer duration of maintained virological response significantly reduces the risk of disease progression or HCC development in CHB patients undergoing long-term oral NA therapy.

Show MeSH

Related in: MedlinePlus

Cumulative incidence rates of hepatocellular carcinoma (HCC) development in subgroup analysis. (A) Age >50 years versus ≤50 years, (B) pre-existing cirrhosis versus noncirrhosis, (C) with or without family history of HCC, (D) duration of maintained virological response ≤12 months versus >12 months. CR, cumulative rate.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4413974&req=5

f3-gnl-09-395: Cumulative incidence rates of hepatocellular carcinoma (HCC) development in subgroup analysis. (A) Age >50 years versus ≤50 years, (B) pre-existing cirrhosis versus noncirrhosis, (C) with or without family history of HCC, (D) duration of maintained virological response ≤12 months versus >12 months. CR, cumulative rate.

Mentions: In the subgroup analysis, the cumulative incidence rates of disease progression were significantly higher among patients with age >50 years versus ≤50 years (1.5% vs 0.9% at 1 year, 10.3% vs 3.8% at 2 years, 14.7% vs 5.5% at 3 years, 19.2% vs 7.2% at 4 years, and 29.3% vs 8.8% at 5 years; p<0.001) (Fig. 2A). The cumulative incidence rates of disease progression were also significantly higher among patients with pre-existing cirrhosis versus noncirrhosis (2.1% vs 0.6% at 1 year, 11.8% vs 3.1% at 2 years, 15.5% vs 5.2% at 3 years, 22.7% vs 5.2% at 4 years, and 30.2% vs 8.0% at 5 years; p<0.001) (Fig. 2B). Furthermore, the cumulative incidence rates of disease progression were significantly lower among patients with longer duration (>12 months) of maintained virological response compared to those with shorter duration (≤12 months) (0.0% vs 3.1% at 1 year, 0.6% vs 16.6% at 2 years, 3.4% vs 19.1% at 3 years, 6.0% vs 21.9% at 4 years, and 10.7% vs 26.2% at 5 years; p<0.001) (Fig. 2C). The cumulative incidence rate of HCC development was significantly higher among patients with age >50 years versus ≤50 years (0.5% vs 0.0% at 1 year, 5.3% vs 0.6% at 2 years, 7.3% vs 1.4% at 3 years, 10.6% vs 3.1% at 4 years, and 19.7% vs 3.7% at 5 years; p<0.001) (Fig. 3A). The cumulative incidence rates of HCC development were also significantly higher among patients with pre-existing cirrhosis versus noncirrhosis (0.5% vs 0.0% at 1 year, 6.1% vs 0.3% at 2 years, 9.4% vs 0.3% at 3 years, 15.6% vs 0.3% at 4 years, and 21.9% vs 2.1% at 5 years; p<0.001) (Fig. 3B). The cumulative incidence rates of HCC development were also significantly higher among patients with family history of HCC versus without family history of HCC (2.3% vs 0.0% at 1 year, 11.7% vs 2.0% at 2 years, 14.9% vs 3.2% at 3 years, 14.9% vs 6.4% at 4 years, and 26.2% vs 9.0% at 5 years; p=0.001) (Fig. 3C). Furthermore, the cumulative incidence rates of HCC development were significantly lower among patients with longer duration (>12 months) of maintained virological response compared to those with shorter duration (≤12 months) (0.0% vs 0.5% at 1 year, 0.3% vs 6.5% at 2 years, 2.1% vs 6.5% at 3 years, 3.8% vs 9.7% at 4 years, and 6.9% vs 13.7% at 5 years; p=0.007) (Fig. 3D).


Disease Progression in Chronic Hepatitis B Patients under Long-Term Antiviral Therapy.

Moon JC, Kim SH, Kim IH, Lee CH, Kim SW, Lee SO, Lee ST, Kim DG - Gut Liver (2015)

Cumulative incidence rates of hepatocellular carcinoma (HCC) development in subgroup analysis. (A) Age >50 years versus ≤50 years, (B) pre-existing cirrhosis versus noncirrhosis, (C) with or without family history of HCC, (D) duration of maintained virological response ≤12 months versus >12 months. CR, cumulative rate.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4413974&req=5

f3-gnl-09-395: Cumulative incidence rates of hepatocellular carcinoma (HCC) development in subgroup analysis. (A) Age >50 years versus ≤50 years, (B) pre-existing cirrhosis versus noncirrhosis, (C) with or without family history of HCC, (D) duration of maintained virological response ≤12 months versus >12 months. CR, cumulative rate.
Mentions: In the subgroup analysis, the cumulative incidence rates of disease progression were significantly higher among patients with age >50 years versus ≤50 years (1.5% vs 0.9% at 1 year, 10.3% vs 3.8% at 2 years, 14.7% vs 5.5% at 3 years, 19.2% vs 7.2% at 4 years, and 29.3% vs 8.8% at 5 years; p<0.001) (Fig. 2A). The cumulative incidence rates of disease progression were also significantly higher among patients with pre-existing cirrhosis versus noncirrhosis (2.1% vs 0.6% at 1 year, 11.8% vs 3.1% at 2 years, 15.5% vs 5.2% at 3 years, 22.7% vs 5.2% at 4 years, and 30.2% vs 8.0% at 5 years; p<0.001) (Fig. 2B). Furthermore, the cumulative incidence rates of disease progression were significantly lower among patients with longer duration (>12 months) of maintained virological response compared to those with shorter duration (≤12 months) (0.0% vs 3.1% at 1 year, 0.6% vs 16.6% at 2 years, 3.4% vs 19.1% at 3 years, 6.0% vs 21.9% at 4 years, and 10.7% vs 26.2% at 5 years; p<0.001) (Fig. 2C). The cumulative incidence rate of HCC development was significantly higher among patients with age >50 years versus ≤50 years (0.5% vs 0.0% at 1 year, 5.3% vs 0.6% at 2 years, 7.3% vs 1.4% at 3 years, 10.6% vs 3.1% at 4 years, and 19.7% vs 3.7% at 5 years; p<0.001) (Fig. 3A). The cumulative incidence rates of HCC development were also significantly higher among patients with pre-existing cirrhosis versus noncirrhosis (0.5% vs 0.0% at 1 year, 6.1% vs 0.3% at 2 years, 9.4% vs 0.3% at 3 years, 15.6% vs 0.3% at 4 years, and 21.9% vs 2.1% at 5 years; p<0.001) (Fig. 3B). The cumulative incidence rates of HCC development were also significantly higher among patients with family history of HCC versus without family history of HCC (2.3% vs 0.0% at 1 year, 11.7% vs 2.0% at 2 years, 14.9% vs 3.2% at 3 years, 14.9% vs 6.4% at 4 years, and 26.2% vs 9.0% at 5 years; p=0.001) (Fig. 3C). Furthermore, the cumulative incidence rates of HCC development were significantly lower among patients with longer duration (>12 months) of maintained virological response compared to those with shorter duration (≤12 months) (0.0% vs 0.5% at 1 year, 0.3% vs 6.5% at 2 years, 2.1% vs 6.5% at 3 years, 3.8% vs 9.7% at 4 years, and 6.9% vs 13.7% at 5 years; p=0.007) (Fig. 3D).

Bottom Line: This retrospective study included 524 naive CHB patients who received oral NA therapy for more than 48 weeks between January 2003 and December 2007.Similarly, age >50 years (HR, 1.05), family history of HCC (HR, 5.48), and cirrhosis (HR, 17.16) were significant factors for HCC development.Longer duration of maintained virological response significantly reduces the risk of disease progression or HCC development in CHB patients undergoing long-term oral NA therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT

Background/aims: We investigated factors associated with the disease progression and development of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients during long-term oral nucleos(t)ide analog (NA) therapy.

Methods: This retrospective study included 524 naive CHB patients who received oral NA therapy for more than 48 weeks between January 2003 and December 2007. The primary outcome was 5-year cumulative probability of disease progression and HCC development. Disease progression was defined as cirrhosis development, cirrhotic complications, HCC or liver-related mortality.

Results: For the 524 patients, the cumulative probabilities of disease progression and HCC development at 1, 2, 3, 4 and 5 years were 1.1%, 6.3%, 9.0%, 11.6%, and 16.2% and 0.2%, 1.8%, 3.6%, 5.8%, and 9.3%, respectively. In multivariate analysis, age >50 years (hazard ratio [HR], 1.05) and cirrhosis (HR, 2.95) were significant factors for disease progression. Similarly, age >50 years (HR, 1.05), family history of HCC (HR, 5.48), and cirrhosis (HR, 17.16) were significant factors for HCC development. Importantly, longer duration (>12 months) of maintained virological response (<20 IU/mL) reduced the risks of disease progression (HR, 0.19) and HCC development (HR, 0.09).

Conclusions: Longer duration of maintained virological response significantly reduces the risk of disease progression or HCC development in CHB patients undergoing long-term oral NA therapy.

Show MeSH
Related in: MedlinePlus