Hepatocellular carcinoma risk in HBeAg-negative chronic hepatitis B patients with or without cirrhosis treated with entecavir: HepNet.Greece cohort

Hepatocellular carcinoma (HCC) may still develop in chronic hepatitis B (CHB) patients treated with lamivudine. Whether HCC rates are comparable in patients treated with the current first-line antivirals remains uncertain. We estimated the incidence and evaluated predictors of HCC in a large nationwide prospective cohort (HepNet.Greece) of HBeAg-negative CHB patients treated with entecavir. HBeAg-negative CHB patients from the same cohort who were initially treated with lamivudine were used as controls. We included 321 patients treated with entecavir for a median of 40 months and 818 patients treated initially with lamivudine for a median of 60 months. In the entecavir group, HCC developed in 4 of 321 (1.2%) patients at a median of 1.5 (range: 1.0-4.5) years, while the cumulative HCC incidence was significantly higher in cirrhotics than noncirrhotics (1, 3, 5 years: 0%, 3%, 9% vs 1%, 1%, 1%; P = 0.024) and in older patients (P = 0.026). Entecavir compared with lamivudine group patients had lower HCC incidence (1, 3, 5 years: 0.3%, 1.2%, 2.8% vs 0.7%, 3.8%, 5.6%; P = 0.024). However, in multivariable Cox regression analysis, the HCC risk was independently associated with older age (P < 0.001), male gender (P = 0.011) and cirrhosis (P = 0.025), but not with the initial agent. In conclusion, our large nationwide study indicates that the HCC risk remains increased in entecavir-treated HBeAg-negative CHB patients with cirrhosis, particularly of older age, at least for the first 5 years. The HCC risk does not seem to be significantly reduced with entecavir compared with antiviral therapy starting with lamivudine.

The significance of the dosage adjustment of octreotide in the treatment of acute pancreatitis of moderate severity

BACKGROUND/AIMS

Octreotide is a novel semisynthetic analogue of somatostatin mainly indicated for acute necrotizing pancreatitis. The aim of the present study was to define its role in the treatment of acute pancreatitis of moderate severity.

METHODOLOGY

One hundred and twenty patients were randomly assigned to three groups of treatment receiving octreotide subcutaneously 100, 200 or 300 micrograms t.i.d. for seven days. Physical examination and biochemical monitoring were performed daily.

RESULTS

No differences were found between the three groups of patients regarding the rate of rebound of leukocytosis and of the elevated serum and urine amylase levels within normal limits. Patients receiving 300 micrograms t.i.d. presented an earlier relief of pain than all others whereas patients receiving octreotide at a dose of either 200 micrograms or 300 micrograms t.i.d. had a shorter duration of hospitalization (12 days) than those receiving octreotide at 100 micrograms t.i.d. (19 days).

CONCLUSIONS

The subcutaneous administration of octreotide in acute pancreatitis of moderate severity might be of little benefit only at a dose of 200 micrograms t.i.d. or 300 micrograms t.i.d. for at least seven days.