Comparable outcomes of decompensated chronic hepatitis B patients treated with entecavir or tenofovir: an 8-year cohort study

Predictive factors and clinical outcomes in decompensated non-cirrhotic chronic hepatitis B patients treated with entecavir or tenofovir disoproxil fumarate

BACKGROUND & AIMS

Little is known about the short-term and long-term outcomes of non-cirrhotic chronic hepatitis B (CHB) patients who experience hepatic decompensation. Therefore, this study aimed to investigate the clinical outcomes of decompensated non-cirrhotic CHB patients.

METHODS

We conducted a retrospective study and enrolled a total of 304 decompensated non-cirrhotic CHB patients. Cox regression model was used to analyze factors associated with all-cause mortality. Additionally, the incidence of HBsAg seroclearance and its associated factors were estimated by the competing risk analysis.

RESULTS

The median follow-up time was 4.36 years (IQR 1.04-7.16). Out of the total enrolled patients, 63 (20.72 %) patients either died or underwent liver transplantation, and 14 patients achieved HBsAg seroclearance. Risk factors associated with 1-month, 3-month, and long-term all-cause mortality were the presence of ascites and hepatic encephalopathy, baseline HBV DNA levels, and MELD scores. The cumulative incidence of HBsAg seroclearance was 1.78 %, 3.72 %, 4.25 %, 5.68 %, 5.68 %, 8.28 %, and 8.28 % at the 1-year, 2-year, 3-year, 4-year, 5-year, 6-year, and 7-year follow-up, respectively. Independent predictors for HBsAg seroclearance were baseline alanine aminotransferase (ALT)≧ 25 times upper limit of normal (subdistribution hazard ratio [sHR] = 5.97; 95 %CI, 1.82-19.63; p = 0.0032) and HBV DNA <5 log10 IU/ml (sHR = 4.43; 95 %CI, 1.55-12.63; p = 0.0054).

CONCLUSIONS

The presence of ascites and hepatic encephalopathy, baseline HBV DNA levels, and MELD scores were associated with short-term and long-term all-cause mortality. Additionally, lower HBV DNA levels and higher ALT levels at baseline were independently predictive of sequential HBsAg seroclearance.

Efficacy and safety of tenofovir and entecavir in patients with chronic hepatitis B-related cirrhosis: a systematic review and meta-analysis

Objectives

To systematically evaluate the efficacy and safety of tenofovir and entecavir in chronic hepatitis B-related cirrhosis.

Methods

A comprehensive search was conducted in databases including PubMed, Web of Science, Embase and Cochrane Library from the inception until June 2024. Studies on the use of tenofovir and entecavir for chronic hepatitis B-related cirrhosis were collected.

Results

A total of 14 studies involving 14,208 patients were included. The meta-analysis revealed that tenofovir significantly reduced the cumulative incidence of hepatocellular carcinoma and cumulative mortality compared to entecavir in East Asian popupation, while in non East Asian populations, the two groups are roughly equivalent. After 48 weeks, the hepatitis B virus-deoxyribonucleic acid clearance rate in the tenofovir group were comparable to the entecavir group. Both tenofovir and entecavir showed similar effect in reducing the incidence of hepatic encephalopathy. Compared with the entecavir group, patients in the tenofovir group, including tenofovir disoproxil fumarate and tenofovir alafenamide fumarate showed a significant increase in estimated glomerular filtration rate after 48 weeks of treatment.

Conclusion

Compared to entecavir, tenofovir significantly reduced the cumulative incidence of hepatocellular carcinoma and cumulative mortality in chronic hepatitis B-related cirrhosis in East Asian population. However, both drugs were comparable in terms of hepatitis B virus-deoxyribonucleic acid clearance and hepatic encephalopathy. Tenofovir did not significantly cause renal dysfunction, but instead improved estimated glomerular filtration rate levels compared with entecavir. Randomized controlled trials with larger sample size are still needed for validation.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024588432.

Determinants of outcomes in patients with hepatitis B virus-decompensated cirrhosis

The role of pre-treatment HBV DNA levels on the prognosis of hepatitis B virus-related decompensated cirrhosis is unclear. This study investigated the effects of pre-treatment HBV DNA and other determinants on short-term and long-term survival of chronic hepatitis B (CHB) patients with decompensated cirrhosis. A total of 278 cirrhotic decompensated CHB patients treated with entecavir or tenofovir disoproxil fumarate were retrospectively enrolled. Cox regression models were used to analyze factors associated with all-cause mortality. The median follow-up time was 17 months (IQR2.17-58.94), during which 132 patients (47.4%) either died or underwent liver transplantation. The cumulative incidence of all-cause mortality was 16%, 29%, 34%, 39%, and 51% at the 1-month, 3-month, 6-month, 1-year, and 5-year follow-ups, respectively. Risk factors associated with 3-month all-cause mortality were age, presence of ascites and hepatic encephalopathy, baseline hepatitis flares, pre-treatment HBV DNA levels, and MELD scores. In the subgroup analysis, for 3-month all-cause mortality, significant associations of age, baseline hepatitis flares, and MELD scores with pre-treatment HBV DNA levels were observed (p for interaction were 0.005, 0.032, and 0.030, respectively). Risk factors associated with 5-year all-cause mortality were age, the presence of ascites and hepatic encephalopathy, and MELD scores. Liver functional reserve and age played a critical role in the prognosis of CHB patients with decompensated cirrhosis. Pre-treatment HBV DNA levels had an impact on short-term all-cause mortality, but not on long-term all-cause mortality.

Expert consensus on the diagnosis and treatment of end-stage liver disease complicated by infections

End-stage liver disease (ESLD) is a life-threatening clinical syndrome and when complicated with infection the mortality is markedly increased. In patients with ESLD, bacterial or fungal infection can induce or aggravate the occurrence or progression of liver decompensation. Consequently, infections are among the most common complications of disease deterioration. There is an overwhelming need for standardized protocols for early diagnosis and appropriate management for patients with ESLD complicated by infections. Asia Pacific region has the largest number of ESLD patients, due to hepatitis B and the growing population of alcohol and NAFLD. Concomitant infections not only add to organ failure and high mortality but also to financial and healthcare burdens. This consensus document assembled up-to-date knowledge and experience from colleagues across the Asia-Pacific region, providing data on the principles as well as evidence-based current working protocols and practices for the diagnosis and treatment of patients with ESLD complicated by infections.

Hepatitis Flares or Hepatic Decompensation after Discontinuation of Tenofovir Disoproxil Fumarate and Entecavir in Non-Cirrhotic Hepatitis B e Antigen-Negative Patients

Hepatic events can occur after discontinuing antiviral therapy. We investigated factors associated with hepatitis flares and hepatic decompensation after discontinuing tenofovir disoproxil fumarate (TDF) and entecavir (ETV). Hepatitis flares within 6 months and hepatic decompensation were compared between non-cirrhotic hepatitis B e antigen-negative patients after discontinuing TDF or ETV by using the Cox proportional hazard model. The cumulative rates of hepatitis flare at 6 months after discontinuing ETV and TDF were 2% and 19%, respectively (p < 0.001). The respective rates of hepatic decompensation at 6 months were 0% and 7% (p = 0.009). Higher alanine aminotransferase (ALT) (AASLD criteria) at the end of treatment (EOT) (HR = 4.93; p = 0.001), an off-therapy dynamic change in HBV DNA (rapid rebound of HBV DNA from the nadir, ≥1 log10 IU/mL per month) (HR = 10.7; p < 0.001), and the discontinuation of TDF (HR = 6.44; p = 0.006) were independently associated with hepatitis flares within 6 months. Older age (HR = 1.06; p < 0.001) and an off-therapy dynamic change in HBV DNA (HR = 3.26; p = 0.028) were independently associated with hepatic decompensation after the discontinuation of antiviral therapy. In summary, we demonstrated several factors associated with hepatitis flares and hepatic decompensation after discontinuing antiviral therapy in non-cirrhotic hepatitis B e antigen-negative patients.