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Wu X, Zhou J, Xie W, Ding H, Ou X, Chen G, Ma A, Xu X, Ma H, Xu Y, Liu X, Meng T, Wang L, Sun Y, Wang B, Kong Y, Ma H, You H, Jia J. Entecavir monotherapy versus de novo combination of lamivudine and adefovir for compensated hepatitis B virus-related cirrhosis: a real-world prospective multicenter cohort study. Infect Drug Resist 2019; 12:745-757. [PMID: 31015765 PMCID: PMC6448536 DOI: 10.2147/idr.s185120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background De novo combination of lamivudine (Lam) and adefovir (Adv) was not rarely used in clinical practice. However, head-to-head comparisons of entecavir (Etv) monotherapy with this combination in hepatitis B virus (HBV)-related compensated cirrhosis patients are unavailable. This study aimed to compare the efficacy and safety of Etv monotherapy with combination therapy in patients with HBV-related compensated liver cirrhosis. Methods Treatment-naïve patients with HBV-related compensated liver cirrhosis were recruited to receive either Etv monotherapy or a de novo combination of Lam and Adv. Data were collected at baseline and every 6 months thereafter. Results A total of 578 patients (485 in Etv group, 93 in combination group) were included. Baseline characteristics were comparable between the two groups. At the end of 1, 2, and 3 years, HBV DNA was undetectable in 82.7%, 96.2%, and 94.3% of patients in the Etv group and 88.9%, 81.7%, and 84.6% in the combination group, respectively (all P>0.05). The cumulative virological breakthrough rate at 1, 2, and 3 years was 2.7%, 6.7%, and 9.8% in the Etv group and 2.9%, 13.3%, and 32.2% in the combination group, respectively (P=0.003). After propensity-score adjustment for age, sex, and baseline HBeAg, ALT, and total bilirubin, virological breakthrough was higher in the de novo combination of Lam and Adv (HR 2.83, 95% CI 1.37–5.86; P<0.01). The cumulative rate of liver-related events, including decompensation and hepatocellular carcinoma, at 1, 2, and 3 years was 2.9%, 4.2%, and 6.1% in the Etv group and 2.2%, 2.2%, and 6.7% in combination group, respectively (P=0.83). Biochemical response and serological response were similar between the groups. Conclusion Etv treatment had less virological breakthrough and potentially higher HBV-DNA suppression than de novo combination of Lam and Adv during 3 years in treatment-naïve HBV-related compensated liver cirrhosis.
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Affiliation(s)
- Xiaoning Wu
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Jialing Zhou
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Wen Xie
- Liver Fibrosis Centre, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Huiguo Ding
- Department of Digestive Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Xiaojuan Ou
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Guofeng Chen
- Liver Fibrosis Centre, Beijing 302 Hospital, Beijing, China
| | - Anlin Ma
- Department of Infectious Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoyuan Xu
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Hui Ma
- Liver Research Centre, Peking University People's Hospital, Beijing, China
| | - Youqing Xu
- Department of Digestive Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqing Liu
- Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Tongtong Meng
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Lin Wang
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Yameng Sun
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Bingqiong Wang
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Yuanyuan Kong
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Hong Ma
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Hong You
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
| | - Jidong Jia
- Liver Research Centre, Beijing Friendship Hospital, Capital Medical University, Beijing, China, ; .,Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, Beijing, China, ; .,National Clinical Research Center of Digestive Diseases, Beijing, China, ;
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Shi H, Han Z, Liu J, Xue J, Zhang S, Zhu Z, Xia J, Huang M. Comparing Efficacy of Lamivudine, Adefovir Dipivoxil, Telbivudine, and Entecavir in Treating Nucleoside Analogues Naïve for HBeAg-Negative Hepatitis B with Medium Hepatitis B Virus (HBV) DNA Levels. Med Sci Monit 2017; 23:5230-5236. [PMID: 29095799 PMCID: PMC5680675 DOI: 10.12659/msm.903382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The antiviral effect of HBV in different nucleos (t) ide analogues is still not well known. This study was conducted to compare the effectiveness of lamivudine (LMV), adefovir dipivoxil (ADV), telbivudine (LdT), and entecavir (ETV) monotherapy in chronic HBeAg-negative hepatitis B patients with medium load of HBV DNA. Material/Methods The effective data of 207 patients treated by LMV (n=43), ADV (n=57), LdT (n=54) or ETV (n=53) were collected and analyzed during 144-week follow-up by retrospective analysis. Results Serum HBV DNA levels were significantly lower in the ETV group 1.91±0.45 log10 IU/ml) than in the LdT group (2.09±0.62 log10 IU/ml), ADV group (2.26±0.73 log10 IU/ml), and LMV group (2.08±0.75 log10 IU/ml) at 12 weeks (P=0.0464). HBV DNA levels were maintained at lower levels in the ETV group compared to other 3 groups during follow-up (48 weeks, P<0.001; 96 weeks, P<0.001). Multivariate Cox regression analysis showed that LMV (P=0.001), ADV, (P<0.001), and LdT (P<0.001) were all negative predictors of HBV DNA-negative time, but ETV was not. Viral breakthrough occurred in 34.8% (15/43) of patients in the LMV group; 5.26% (3/57) in the ADV group, 7.4.0% (4/54) in the LdT group, and 0% (0/53) in the ETV group at the end of follow-up. No significant differences were found in mean ALT levels (all P>0.05) or in cumulative normalization rates (P=0.473). Conclusions ETV was more potent and faster for viral response and lower viral breakthrough in medium load of HBV DNA when compared to LMV, ADV, or LdT monotherapy in HBeAg-negative CHB.
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Affiliation(s)
- Hong Shi
- Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Zongping Han
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China (mainland)
| | - Jian Liu
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China (mainland)
| | - Jinfang Xue
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China (mainland)
| | - Shuya Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China (mainland)
| | - Zhe Zhu
- Department of Stem Cell Biology and Regenerative Medicine, Cleveland Clinic, Lerner Research Institute, Cleveland, OH, USA
| | - Jinyu Xia
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China (mainland)
| | - Mingxing Huang
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China (mainland)
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Zhang C, Ke W, Gao Y, Zhou S, Liu L, Ye X, Yao Z, Yang Y. Cost-effectiveness analysis of antiviral therapies for hepatitis B e antigen-positive chronic hepatitis B patients in China. Clin Drug Investig 2015; 35:197-209. [PMID: 25672930 DOI: 10.1007/s40261-015-0273-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Several antiviral therapies are now available for patients with chronic hepatitis B (CHB), but the most cost-effective strategy for Chinese patients is unclear. The aim of this study was to estimate the long-term cost effectiveness of the antiviral treatments (lamivudine, adefovir, telbivudine and entecavir) for hepatitis B e antigen (HBeAg)-positive CHB patients in China. METHODS A Markov model was used to simulate the life-time (41-year time span) costs and effectiveness associated with antiviral treatments from the perspective of Chinese healthcare. Relative model parameters were derived from Chinese population studies. Costs and effectiveness were discounted at 5 %. The highest retail prices for generic and branded drug prices were also considered. Probabilistic sensitivity analysis and one-way sensitivity analysis were used to explore model uncertainties. RESULTS In the base-case analysis, the least quality-adjusted life years (QALYs) were obtained with adefovir as the reference strategy. Lamivudine generated the highest incremental cost-effectiveness ratio (ICER), with an additional US$35,000 needed to gain one additional QALY for generic drugs and US$36,000 for branded drugs. Entecavir had the lowest ICER of US$7,600 and US$9,100, respectively. The projected 10-year cumulative incidences of compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma (HCC) and mortality for entecavir were lower than the other strategies. In probabilistic sensitivity analyses, entecavir was the preferred option at a threshold of US$18,924 per QALY. CONCLUSIONS In patients with HBeAg-positive CHB in China, entecavir is a cost-effective option compared with other therapies for CHB.
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Affiliation(s)
- Chi Zhang
- Department of Epidemiology and Biostatistics and Guangdong Key Lab of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310, Guangdong, China
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Stalke P, Rybicka M, Wróblewska A, Dreczewski M, Stracewska E, Smiatacz T, Bielawski KP. An initial assessment of correlations between host- and virus-related factors affecting analogues antiviral therapy in HBV chronically infected patients. Med Sci Monit 2014; 20:321-8. [PMID: 24569300 PMCID: PMC3943711 DOI: 10.12659/msm.889788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 11/07/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Success in treating hepatitis B virus (HBV) infection with nucleoside analogues drugs is limited by the emergence of drug-resistant viral strains upon prolonged therapy. In addition to mutation patterns in the viral polymerase gene, host factors are assumed to contribute to failure of treatment in chronic HBV infections. The aim of this study was to analyze the correlation between efficacy of antiviral therapy and the prevalence of HBV pretreatment drug-resistant variants. We also analyzed the role of heterogeneity in the promoter region of the IL-10 on the HBV pol/s gene polymorphisms and efficacy of analogues-driven therapy. MATERIAL AND METHODS HBV DNA was extracted from 54 serum samples from chronic hepatitis B (CHB) patients. Drug-resistance mutations were analyzed using MALDI-TOF mass spectrometry technology (MALDI-TOF MS) and Multi-temperature single-strand conformation polymorphism (MSSCP). IL-10 gene promoter region polymorphisms at positions -1082, -819, and -592 were determined in allele-specific PCR reactions (AS-PCR). RESULTS Drug-resistance mutations were detected in 74% of naïve and 93% of experienced patients, but the effect of pre-existence of drug-resistant HBV variants on antiviral therapy was not statistically significant (p=0.86). The role of polymorphisms at positions -1082 (p=0.88), -819 (p=0.26), and -592 (p=0.26) of IL-10 promoter region polymorphisms was excluded from the response-predicting factors. The main host factors predicting successful response to antiviral therapy were female sex (p=0.007) and young age (p=0.013). CONCLUSIONS The presence of drug-resistant HBV variants in baseline is not a viral predictor of good response to nucleoside/nucleotide analogues therapy. Only low HBV viral load predicted positive response to antiviral therapy. The ideal candidate for antiviral therapy is an immunocompetent, young female with low HBV viral load and elevated ALT activity.
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Affiliation(s)
- Piotr Stalke
- Department of Infectious Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Magda Rybicka
- Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Wróblewska
- Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Dreczewski
- Department of Infectious Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Stracewska
- Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Smiatacz
- Department of Infectious Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Piotr Bielawski
- Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, Gdańsk, Poland
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