Ken Liu1,2, Jonggi Choi3, An Le4, Terry Cheuk-Fung Yip5,6, Vincent Wai-Sun Wong5,6, Stephen Lam Chan5,7, Henry Lik-Yuen Chan5,6, Mindie H Nguyen4, Young-Suk Lim3, Grace Lai-Hung Wong5,6. 1. AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 2. Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 3. Department of Gastroenterology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea. 4. Division of Gastroenterology and Hepatology, Stanford University Medical Centre, Stanford, CA, USA. 5. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong. 6. Institute of Digestive Disease and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong. 7. Department of Clinical Oncology and State Key Laboratory of Translation Oncology, Sir YK Pao Centre for Cancer, Hong Kong, Hong Kong.
Abstract
BACKGROUND: Lamivudine and entecavir reduce hepatic events and death in chronic hepatitis B (CHB) patients with cirrhosis, but the impact of tenofovir disoproxil fumarate (TDF) is less well studied. AIM: To investigate the effectiveness of TDF therapy in CHB patients with cirrhosis. METHODS: We studied TDF-treated and untreated CHB patients with cirrhosis from three tertiary centres. TDF cohort included consecutive patients who received TDF for ≥12 months while the untreated cohort were historical controls receiving routine clinical care prior to the availability of anti-viral therapy. The primary outcome was 5-year cumulative probability of hepatocellular carcinoma (HCC) with secondary outcomes being hepatic decompensation and death or liver transplantation (LT). RESULTS: A total of 1088 (291 untreated and 797 TDF-treated) patients were included in the study. Five-year cumulative probabilities in untreated vs TDF-treated cohorts were 14.9% vs 9.8% for HCC (P = .07), 22.3% vs 5.9% for decompensation (P < .01) and 13.1% vs 1.1% for death or LT (P < .01) respectively. On multivariable Cox regression, TDF treatment was independently associated with reduced risks of HCC (adjusted hazard ratio [aHR] 0.46, P < .01), decompensating events (aHR 0.28, P = .01) and death or LT (aHR 0.06, P < .01). On sensitivity analyses, these risk reductions with TDF treatment were consistently demonstrated regardless of severity of liver disease and prior anti-viral treatment. TDF treatment led to sustained improvements in most validated prognostic scores for predicting HCC, decompensation and death. CONCLUSIONS: Compared to untreated patients, TDF treatment reduces the risks of HCC, hepatic decompensation and death in CHB patients with cirrhosis at 5 years.
BACKGROUND:Lamivudine and entecavir reduce hepatic events and death in chronic hepatitis B (CHB) patients with cirrhosis, but the impact of tenofovir disoproxil fumarate (TDF) is less well studied. AIM: To investigate the effectiveness of TDF therapy in CHB patients with cirrhosis. METHODS: We studied TDF-treated and untreated CHB patients with cirrhosis from three tertiary centres. TDF cohort included consecutive patients who received TDF for ≥12 months while the untreated cohort were historical controls receiving routine clinical care prior to the availability of anti-viral therapy. The primary outcome was 5-year cumulative probability of hepatocellular carcinoma (HCC) with secondary outcomes being hepatic decompensation and death or liver transplantation (LT). RESULTS: A total of 1088 (291 untreated and 797 TDF-treated) patients were included in the study. Five-year cumulative probabilities in untreated vs TDF-treated cohorts were 14.9% vs 9.8% for HCC (P = .07), 22.3% vs 5.9% for decompensation (P < .01) and 13.1% vs 1.1% for death or LT (P < .01) respectively. On multivariable Cox regression, TDF treatment was independently associated with reduced risks of HCC (adjusted hazard ratio [aHR] 0.46, P < .01), decompensating events (aHR 0.28, P = .01) and death or LT (aHR 0.06, P < .01). On sensitivity analyses, these risk reductions with TDF treatment were consistently demonstrated regardless of severity of liver disease and prior anti-viral treatment. TDF treatment led to sustained improvements in most validated prognostic scores for predicting HCC, decompensation and death. CONCLUSIONS: Compared to untreated patients, TDF treatment reduces the risks of HCC, hepatic decompensation and death in CHB patients with cirrhosis at 5 years.
Authors: Eleanor Barnes; Philippa C Matthews; Tingyan Wang; David A Smith; Cori Campbell; Jolynne Mokaya; Oliver Freeman; Hizni Salih; Anna L McNaughton; Sarah Cripps; Kinga A Várnai; Theresa Noble; Kerrie Woods; Jane Collier; Katie Jeffery; Jim Davies Journal: BMC Infect Dis Date: 2021-06-26 Impact factor: 3.090