More than 95% of people with chronic
hepatitis B were still alive after five years on antiviral therapy with
entecavir (Baraclude) or tenofovir (Viread) and most deaths were due to
non-liver-related causes, according to research presented at the European Association
for the Study of the Liver (EASL) 50th International Liver Congress recently
held in Vienna, Austria. Liver cancer was still a major factor
affecting mortality, however.
Antiviral therapy using nucleoside/nucleotide analogues
such as lamivudine, entecavir or tenofovir is the mainstay of chronic hepatitis
B treatment. While these drugs can effectively
suppress hepatitis B virus (HBV)
replication during therapy, they usually do not lead to a cure and
long-term treatment may be needed.
Over years or decades, chronic HBV infection can lead
to advanced liver disease including cirrhosis and hepatocellular carcinoma, a
type of liver cancer. Prior research indicates that maintaining viral
suppression on treatment can help prevent disease progression. But as entecavir
and tenofovir were approved for hepatitis B treatment in 2005 and 2008,
respectively, long-term data are still needed.
- compensated cirrhosis
The earlier stage of
cirrhosis, during which the liver is damaged but still able to perform most of
its functions. See also ‘cirrhosis’ and ‘decompensated cirrhosis’.
- hepatocellular carcinoma (HCC)
Liver cancer. A long-term complication of chronic inflammation of the liver or cirrhosis.
George Papatheodoridis from Athens
University Medical School in Greece and colleagues evaluated outcomes and
survival among Caucasian people with chronic hepatitis B treated with entecavir or
tenofovir. Hepatitis B is endemic in Asia and much of the research to date has
involved people of Asian origin, so less is known about Caucasians with HBV.
This ongoing cohort study included 1815
people with chronic hepatitis B, with or without liver cirrhosis, all Caucasian, at
nine centres in Europe, Turkey and Canada. About 70% of participants were men
and the mean age was 53. Over a quarter had compensated cirrhosis at
baseline, but none had hepatocellular carcinoma. All participants received
either entecavir or tenofovir for at least 12 months. A majority (60%) had not
previously used antiviral therapy before this study.
Among the total patient population,
survival rates without liver transplantation were high overall: 99.5% at one
year, 98.5% at two years, 97.5% at three years and 95.0% at five years. Survival
rates were significantly higher for people without cirrhosis (100%, 99.0%, 98.5%
and 97.0%, respectively) compared to those with cirrhosis (98%, 96.5%, 95.0%
When only liver-related deaths or liver
transplantation were taken into account, survival rates were even higher: 99.7%, 99.4%, 99.0% and 97.5%, respectively. Again,
survival was significantly higher among people without cirrhosis (100%, 100%,
100% and 99.0%) compared to people with cirrhosis (99.0%, 98.0%, 97.0% and
When people who developed hepatocellular
carcinoma were excluded, survival rates were 99.5%, 99.0%, 98.0% and 96.5%,
respectively. Here again, survival was higher for people without cirrhosis compared to
those with cirrhosis.
However, among the 85 people who
developed hepatocellular carcinoma, survival rates after liver cancer diagnosis
were much lower: 76.0% at one year and 56.0% at three years. Within this group
there was no longer a survival difference between people with or without cirrhosis.
In a multivariate analysis, higher overall survival
was independently associated with absence of hepatocellular carcinoma (hazard
ratio [HR] 6.45) and younger age (HR 1.04 per year), but not with sex or
cirrhosis. Considering only liver-related deaths, higher survival was
independently associated only with absence of hepatocellular carcinoma (HR
"The survival of Caucasian chronic
hepatitis B patients treated with [entecavir or tenofovir] is excellent with
>95% of cases surviving at five years and a significant proportion of deaths
coming from liver unrelated causes," the researchers concluded.
However, they continued, "Hepatocellular
carcinoma development is a major factor affecting the overall mortality and the
only factor affecting liver-related mortality in such patients."