Tenofovir, entecavir, and lamivudine in patients with severe acute exacerbation and hepatic decompensation of chronic hepatitis B.
OBJECTIVE To compare the efficacy of and mortality after lamivudine (LAM) tenofovir (TDF) and entecavir (ETV) treatment in patients with severe acute chronic hepatitis B (CHB) exacerbation. METHODS We analyzed 91 patients with severe acute CHB exacerbation treated with LAM (n=28) TDF (n=26) or ETV (n=37) for 10 years. The primary endpoint was overall mortality or liver transplantation (LT) by 48 weeks. The determined predictors of mortality, virologic and biochemical responses, and drug resistance were also evaluated. RESULTS The overall mortality or LT rate was not significantly different among the LAM (14.3% ETV (10.8% and TDF (3.8% groups (P=0.435) In the multivariate analysis, the occurrence of ascites (hazard ratio [HR] 10.467, 95% confidence interval [CI] 1.596 68.645, P=0.014) and model for end stage liver disease (MELD) scores above 25 (HR 28.920, CI 4.719 177.251, P=0.000) increased the risk of mortality or LT. All groups showed similar biochemical responses (P=0.134) virologic responses (HBV DNA <116copies/mL, P=0.151) and HBeAg seroconversion (P=0.560) Antiviral resistance emerged in five patients treated with LAM by 48 weeks (17.9% P=0.003) CONCLUSION LAM, ETV, and TDF selection is not related with mortality and LT in patients with severe acute CHB exacerbation and hepatic decompensation. To reduce mortality, patients with ascites and MELD scores above 25 should be considered for LT.
Digestive and liver disease official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver