Document Detail

Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection.
MedLine Citation:
PMID:  23213040     Owner:  NLM     Status:  MEDLINE    
Chronic hepatitis B virus (HBV) infection leads to cirrhosis and hepatocellular carcinoma (HCC). Antiviral agents are thought to reduce HCC development, but agents such as lamivudine (LAM) have a high rate of drug resistance. We compared the incidence of HCC in 472 entecavir (ETV)-treated patients and 1,143 nontreated HBV patients (control group). Propensity score matching eliminated the baseline differences, resulting in a sample size of 316 patients per cohort. The drug mutation resistance was 0.8% (4/472) in the ETV group. The cumulative HCC incidence rates at 5 years were 3.7% and 13.7% for the ETV and control groups, respectively (P < 0.001). Cox proportional hazard regression analysis, adjusted for a number of known HCC risk factors, showed that patients in the ETV group were less likely to develop HCC than those in the control group (hazard ratio: 0.37; 95% confidence interval: 0.15-0.91; P = 0.030). Both cohorts were applied in three previously reported risk scales and risk scores were generated based on age, gender, cirrhosis status, levels of alanine aminotransferase, hepatitis B e antigen, baseline HBV DNA, albumin, and bilirubin. The greatest HCC risk reduction occurred in high-risk patients who scored higher on respective risk scales. In sub analyses, we compared treatment effect between nucleos(t)ide analogs, which included matched LAM-treated patients without rescue therapy (n = 182). We found HCC suppression effect greater in ETV-treated (P < 0.001) than nonrescued LAM-treated (P = 0.019) cirrhosis patients when they were compared with the control group. Conclusion: Long-term ETV treatment may reduce the incidence of HCC in HBV-infected patients. The treatment effect was greater in patients at higher risk of HCC.
Tetsuya Hosaka; Fumitaka Suzuki; Masahiro Kobayashi; Yuya Seko; Yusuke Kawamura; Hitomi Sezaki; Norio Akuta; Yoshiyuki Suzuki; Satoshi Saitoh; Yasuji Arase; Kenji Ikeda; Mariko Kobayashi; Hiromitsu Kumada
Publication Detail:
Type:  Journal Article     Date:  2013-03-06
Journal Detail:
Title:  Hepatology (Baltimore, Md.)     Volume:  58     ISSN:  1527-3350     ISO Abbreviation:  Hepatology     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-26     Completed Date:  2013-08-30     Revised Date:  2014-05-29    
Medline Journal Info:
Nlm Unique ID:  8302946     Medline TA:  Hepatology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-107     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Association for the Study of Liver Diseases.
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MeSH Terms
Carcinoma, Hepatocellular / epidemiology,  etiology,  prevention & control*
Cohort Studies
Drug Resistance, Viral / genetics
Guanine / analogs & derivatives*,  therapeutic use
Hepatitis B, Chronic / complications,  drug therapy*
Lamivudine / therapeutic use
Liver Neoplasms / epidemiology,  etiology,  prevention & control*
Middle Aged
Retrospective Studies
Reg. No./Substance:
0/entecavir; 2T8Q726O95/Lamivudine; 5Z93L87A1R/Guanine
Comment In:
Hepatology. 2013 Jul;58(1):18-20   [PMID:  23401270 ]
Hepatology. 2014 May;59(5):2053   [PMID:  24122900 ]
Hepatology. 2014 May;59(5):2053-4   [PMID:  24122922 ]
Gastroenterology. 2013 Nov;145(5):1155-6   [PMID:  24055637 ]

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