Entecavir versus lamivudine in the treatment of chronic hepatitis B patients with hepatic decompensation.
BACKGROUND
Lamivudine has been widely used in chronic hepatitis B patients with hepatic decompensation, but its use is limited by drug resistance. This outcome research aimed to investigate the comparative efficacy and safety of entecavir versus lamivudine in decompensated patients.


METHODS
Between November 2004 and February 2010, 126 consecutive treatment-naive patients received either entecavir (n=53) or lamivudine (n=73) for decompensated chronic hepatitis B. All patients presented with both hyperbilirubinaemia and coagulopathy. Primary outcome was mortality within 1 year; secondary outcomes included liver-related mortality, biochemical and virological response, and improvement of hepatic dysfunction.


RESULTS
Both treatment groups were comparable in baseline characteristics. A total of 19 (35.8%) entecavir and 33 (45.2%) lamivudine receivers expired within 1 year, respectively (P=0.29, log rank test). Age (hazard ratio [HR] 1.04 per year, 95% CI 1.01, 1.06), cirrhosis (HR 2.07, 95% CI 1.02, 4.23), and international normalized ratio for prothrombin time (HR 1.44, 95% CI 1.20, 1.74) were independent baseline predictors for all-cause mortality. Antiviral therapy was also unrelated to liver-specific death. However, more patients taking entecavir tended to attain aminotransferase normalization (76.5% versus 52.5%; P=0.05) and viral DNA undetectability (100% versus 58.3%; P=0.06). Moreover, entecavir was associated with significantly greater reduction of the model for end-stage liver disease scores (median 10.0 versus 4.3; P=0.02). Overall, 3 (7.5%) lamivudine but no entecavir users acquired drug resistance in 1 year (P=0.25).


CONCLUSIONS
Entecavir as compared with lamivudine is similar in the effect on short-term mortality but is associated with greater clinical improvement among chronic hepatitis survivors who recovered from hepatic decompensation.
Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
Yao-Chun
YC
Hsu
Lein-Ray
LR
Mo
Chi-Yang
CY
Chang
Daw-Shyong
DS
Perng
Cheng-Hao
CH
Tseng
Gin-Ho
GH
Lo
Chih-Min
CM
Tai
Chih-Wen
CW
Lin
Chia-Chang
CC
Hsu
Chuan-Yuan
CY
Hsu
Shih-Che
SC
Huang
Jaw-Town
JT
Lin
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D017093:Liver Failure / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000998:Antiviral Agents; D019259:Lamivudine; C413685:entecavir; D006147:Guanine