title: Comparison of the efficacies of lamivudine versus entecavir in patients with hepatitis B virus-related decompensated cirrhosis.
abstract: BACKGROUND
  Suppression of hepatitis B virus (HBV) DNA is more potent, and occurrence of resistant strain is rare with entecavir than lamivudine, but whether these merits result in a more favourable outcome in HBV-related decompensated cirrhosis patients is unclear.
  
  
  OBJECTIVE
  To compare virologic response, changes in liver function, clinical course and predictive factors for early mortality after treatment between patients treated with lamivudine and those with entecavir in HBV-related decompensated cirrhosis patients.
  
  
  METHODS
  HBV-related decompensated cirrhosis patients [Child-Turcotte-Pugh (CTP) score ≥ 7] treated with either lamivudine or entecavir were enrolled. Serum HBV DNA levels, CTP score and Model for End-stage Liver Disease (MELD) score were monitored every 3 months.
  
  
  RESULTS
  Eighty-six patients were enrolled; mean age was 54 ± 11 years, and 63 (73.3%) patients were men; 41 (47.7%) and 45 (52.3%) patients were assigned to the lamivudine group and entecavir group respectively. Although suppression of serum HBV DNA level was more potent in the entecavir group, CTP or MELD scores during the course of treatment did not differ between the two groups. Similarly, 6-month survival rates did not differ between the two groups (95.1 vs 93.2%, P = 0.684). Baseline CTP score and MELD score at 3 months of treatment were significantly associated with 6-month mortality. The 6- and 12-month mortality rates for patients with baseline CTP score ≥ 11 and MELD score ≥ 17.5 after 3 months of treatment were 42.9 and 61.9% respectively.
  
  
  CONCLUSIONS
  Although HBV DNA suppression was more potent in the entecavir group than the lamivudine group, early mortality rates did not differ between the two groups. The baseline CTP score and MELD score 3 months after initiating antiviral treatment were significant predictors of early mortality.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Hyun
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Eileen
authors.initials: E
authors.lastname: Yoon
authors.forename: Tae Hyung
authors.initials: TH
authors.lastname: Kim
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Kim
authors.forename: Hyun Seok
authors.initials: HS
authors.lastname: Kang
authors.forename: Eun Suk
authors.initials: ES
authors.lastname: Jung
authors.forename: Jeong Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyonggin
authors.initials: H
authors.lastname: An
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Jong Eun
authors.initials: JE
authors.lastname: Yeon
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Kwan Soo
authors.initials: KS
authors.lastname: Byun
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006509:Hepatitis B / Q000150:complications*; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea; D014766:Viremia
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine; C413685:entecavir; D006147:Guanine