Clinical Outcomes of Lamivudine-Adefovir Therapy in Chronic Hepatitis B Cirrhosis

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Clinical Outcomes of Lamivudine-Adefovir Therapy in Chronic Hepatitis B

Cirrhosis

Journal of Clinical Gastroenterology, 09/16/2011 Clinical Article

Lim SG et al. – Decompensated chronic hepatitis B cirrhotics may suffer early

mortality despite antiviral treatment, and therefore should be considered for

early liver transplantation.

Methods

• Large clinic cohort of chronic hepatitis B cirrhotic patients were enrolled

in a treatment program of lamivudine±adefovir therapy.

• Patients were analyzed for clinical outcomes, and predictors of these

outcomes were evaluated by multivariate analysis.

• Clinical outcomes of ascites, encephalopathy, hepatocellular carcinoma

(HCC), and progression in Child-Pugh score, Model for End-stage Liver Disease

score, and mortality were assessed.

• Data were analyzed by Kaplan-Meier graphs, log-rank test, and

regression.

Results• Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated

cirrhosis.

• At 5 years, the mean survival was 83.6%, development of ascites, HCC,

encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%,

and 16.9%, respectively.

• Overall progression of liver-related complications was 32.8% at 5 years.

• Multivariate analysis showed that ascites, albumin ≤28 g/L, Child-Pugh

score & ge:7.9, Model for End-stage Liver Disease score ≥10.9 were

significantly associated with liver-related complications.

• Low albumin and low hepatitis B virus DNA were independent factors for

liver-associated mortality.

• Lamivudine resistance did not affect mortality or liver disease progression.

• When stratified by Child-Pugh status, the mean survival of those with Child

C cirrhosis was worse than Child A and B cirrhosis (P<0.001, log-rank test).

• Early deaths (≤12 mo) were due to liver failure or sepsis, whereas deaths

≥12 mo were mainly due to HCC.

----------------------------------------------------

http://journals.lww.com/jcge/Abstract/2011/10000/Clinical_Outcomes_of_Lamivudine\

_Adefovir_Therapy.18.aspx

Journal of Clinical Gastroenterology:

October 2011 - Volume 45 - Issue 9 - p 818–823

doi: 10.1097/MCG.0b013e318214ab5d

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Clinical Outcomes of Lamivudine-Adefovir Therapy in Chronic Hepatitis B

Cirrhosis

Lim, Seng Gee FRCP*,†,‡; Aung, Myat Oo MBBS*; Mak, Belinda SRN*; Sutedja,

Dede MRCP*; Lee, Yin Mei MRCP*; Lee, Guan Huei MRCP*; Fernandes, Mark MRCP*;

Low, How Cheng MRCP*; Lai, PhD*; Dan, Yock Young MRCP*,‡

Abstract

Goals: To determine the clinical outcome of chronic hepatitis B cirrhotics on

antiviral therapy.

Background: The long-term outcome of hepatitis B cirrhotics on therapy remains

to be characterized.

Methods: A large clinic cohort of chronic hepatitis B cirrhotic patients were

enrolled in a treatment program of lamivudine±adefovir therapy. Patients were

analyzed for clinical outcomes, and predictors of these outcomes were evaluated

by multivariate analysis. Clinical outcomes of ascites, encephalopathy,

hepatocellular carcinoma (HCC), and progression in Child-Pugh score, Model for

End-stage Liver Disease score, and mortality were assessed. Data were analyzed

by Kaplan-Meier graphs, log-rank test, and regression.

Results: Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated

cirrhosis. At 5 years, the mean survival was 83.6%, development of ascites, HCC,

encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%,

and 16.9%, respectively. The overall progression of liver-related complications

was 32.8% at 5 years. Multivariate analysis showed that ascites, albumin ≤28

g/L, Child-Pugh score ≥7.9, Model for End-stage Liver Disease score ≥10.9

were significantly associated with liver-related complications. Low albumin and

low hepatitis B virus DNA were independent factors for liver-associated

mortality. Lamivudine resistance did not affect mortality or liver disease

progression. When stratified by Child-Pugh status, the mean survival of those

with Child C cirrhosis was worse than Child A and B cirrhosis (P<0.001, log-rank

test). Early deaths (≤12 mo) were due to liver failure or sepsis, whereas

deaths ≥12 mo were mainly due to HCC.

Conclusion: Decompensated chronic hepatitis B cirrhotics may suffer early

mortality despite antiviral treatment, and therefore should be considered for

early liver transplantation.

[Guest guest]

http://www.mdlinx.com/infectious-disease/newsl-article.cfm/3754949/ZZ68065536792\

5639220014/?news_id=497 & newsdt=091611 & subspec_id=130

Clinical Outcomes of Lamivudine-Adefovir Therapy in Chronic Hepatitis B

Cirrhosis

Journal of Clinical Gastroenterology, 09/16/2011 Clinical Article

Lim SG et al. – Decompensated chronic hepatitis B cirrhotics may suffer early

mortality despite antiviral treatment, and therefore should be considered for

early liver transplantation.

Methods

• Large clinic cohort of chronic hepatitis B cirrhotic patients were enrolled

in a treatment program of lamivudine±adefovir therapy.

• Patients were analyzed for clinical outcomes, and predictors of these

outcomes were evaluated by multivariate analysis.

• Clinical outcomes of ascites, encephalopathy, hepatocellular carcinoma

(HCC), and progression in Child-Pugh score, Model for End-stage Liver Disease

score, and mortality were assessed.

• Data were analyzed by Kaplan-Meier graphs, log-rank test, and

regression.

Results• Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated

cirrhosis.

• At 5 years, the mean survival was 83.6%, development of ascites, HCC,

encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%,

and 16.9%, respectively.

• Overall progression of liver-related complications was 32.8% at 5 years.

• Multivariate analysis showed that ascites, albumin ≤28 g/L, Child-Pugh

score & ge:7.9, Model for End-stage Liver Disease score ≥10.9 were

significantly associated with liver-related complications.

• Low albumin and low hepatitis B virus DNA were independent factors for

liver-associated mortality.

• Lamivudine resistance did not affect mortality or liver disease progression.

• When stratified by Child-Pugh status, the mean survival of those with Child

C cirrhosis was worse than Child A and B cirrhosis (P<0.001, log-rank test).

• Early deaths (≤12 mo) were due to liver failure or sepsis, whereas deaths

≥12 mo were mainly due to HCC.

----------------------------------------------------

http://journals.lww.com/jcge/Abstract/2011/10000/Clinical_Outcomes_of_Lamivudine\

_Adefovir_Therapy.18.aspx

Journal of Clinical Gastroenterology:

October 2011 - Volume 45 - Issue 9 - p 818–823

doi: 10.1097/MCG.0b013e318214ab5d

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Clinical Outcomes of Lamivudine-Adefovir Therapy in Chronic Hepatitis B

Cirrhosis

Lim, Seng Gee FRCP*,†,‡; Aung, Myat Oo MBBS*; Mak, Belinda SRN*; Sutedja,

Dede MRCP*; Lee, Yin Mei MRCP*; Lee, Guan Huei MRCP*; Fernandes, Mark MRCP*;

Low, How Cheng MRCP*; Lai, PhD*; Dan, Yock Young MRCP*,‡

Abstract

Goals: To determine the clinical outcome of chronic hepatitis B cirrhotics on

antiviral therapy.

Background: The long-term outcome of hepatitis B cirrhotics on therapy remains

to be characterized.

Methods: A large clinic cohort of chronic hepatitis B cirrhotic patients were

enrolled in a treatment program of lamivudine±adefovir therapy. Patients were

analyzed for clinical outcomes, and predictors of these outcomes were evaluated

by multivariate analysis. Clinical outcomes of ascites, encephalopathy,

hepatocellular carcinoma (HCC), and progression in Child-Pugh score, Model for

End-stage Liver Disease score, and mortality were assessed. Data were analyzed

by Kaplan-Meier graphs, log-rank test, and regression.

Results: Of 143 chronic hepatitis B cirrhotics, 19.6% had decompensated

cirrhosis. At 5 years, the mean survival was 83.6%, development of ascites, HCC,

encephalopathy, and deterioration in Child-Pugh score were 7.0%, 15.9%, 10.8%,

and 16.9%, respectively. The overall progression of liver-related complications

was 32.8% at 5 years. Multivariate analysis showed that ascites, albumin ≤28

g/L, Child-Pugh score ≥7.9, Model for End-stage Liver Disease score ≥10.9

were significantly associated with liver-related complications. Low albumin and

low hepatitis B virus DNA were independent factors for liver-associated

mortality. Lamivudine resistance did not affect mortality or liver disease

progression. When stratified by Child-Pugh status, the mean survival of those

with Child C cirrhosis was worse than Child A and B cirrhosis (P<0.001, log-rank

test). Early deaths (≤12 mo) were due to liver failure or sepsis, whereas

deaths ≥12 mo were mainly due to HCC.

Conclusion: Decompensated chronic hepatitis B cirrhotics may suffer early

mortality despite antiviral treatment, and therefore should be considered for

early liver transplantation.