Flares during long-term entecavir therapy in chronic hepatitis B

Autor: Chi, Heng, Arends, Pauline, Reijnders, Jurriën, Carey, I, Brown, A, Fasano, M, Mutimer, D, Deterding, K, Oo, Y H, Petersen, J, van Bommel, F, de Knegt, Rob, Santantonio, T A, Berg, T, Welzel, TM, Wedemeyer, H, Buti, M, Pradat, P, Zoulim, F, Hansen, Bettina, Janssen, HLA
Přispěvatelé: Forest Research, Alice Holt Lodge, Medcom [Odense], Norwegian Institute for Air Research (NILU), Norwegian University of Science and Technology [Trondheim] (NTNU), Norwegian University of Science and Technology (NTNU), Equipe 16, Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche en Cancérologie de Lyon (CRCL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Gastroenterology & Hepatology
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Zdroj: Journal of Gastroenterology and Hepatology
Journal of Gastroenterology and Hepatology, Wiley, 2016, 31 (11), pp.1882-1887. ⟨10.1111/jgh.13377⟩
Journal of Gastroenterology and Hepatology, 31(11), 1882-1887. Wiley-Blackwell Publishing Ltd
ISSN: 0815-9319
1440-1746
DOI: 10.1111/jgh.13377⟩
Popis: International audience; BACKGROUND AND AIM: The incidence and consequences of flares during first-line nucleos(t)ide analogue therapy are largely unknown. We aimed to investigate the incidence and outcome of alanine aminotransferase (ALT) flares during long-term entecavir (ETV) in chronic hepatitis B (CHB). METHODS: CHB patients treated with ETV monotherapy from 11 European centers were studied. Flare was defined as \textgreater 3x increase in ALT compared with baseline or lowest on-treatment level and an absolute ALT \textgreater 3x ULN. Flares were designated as host-induced (preceded by hepatitis B virus (HBV)-DNA decline), virus-induced (HBV-DNA increase), or indeterminate (stable HBV-DNA). RESULTS: Seven hundred and twenty-nine patients were treated with ETV for median of 3.5 years. Thirty patients developed a flare with cumulative incidence of 6.3% at year 5. Baseline hepatitis B e antigen (HBeAg)-positivity (HR 2.84; P = 0.005) and high HBV-DNA (Hazard ratio (HR) 1.30; P = 0.003) predicted flares. There were 12 (40%) host-induced, 7 (23%) virus-induced, and 11 (37%) indeterminate flares. Host-induced flares occurred earlier than virus-induced (median: 15 vs 83 weeks; P = 0.027) or indeterminate flares (15 vs 109 weeks; P = 0.011). Host-induced flares were associated with biochemical remission, and HBeAg (n = 3) and hepatitis B surface antigen (n = 2) seroconversions were exclusively observed among patients with these flares. Virus-induced flares were associated with ETV resistance (n = 2) and non-compliance (n = 1). CONCLUSION: The incidence of ALT flares during ETV was low in this real-life cohort. ETV can be safely continued in patients with host-induced flares. Treatment adherence and drug resistance must be assessed in patients with virus-induced flares
Databáze: OpenAIRE
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