title: Entecavir treatment reduces hepatic events and deaths in chronic hepatitis B patients with liver cirrhosis.
abstract: Entecavir is a potent antiviral agent with high genetic barrier to resistance, hence it is currently recommended as first-line antiviral therapy for chronic hepatitis B (CHB). The aim of this study was to investigate the efficacy of entecavir on clinical outcomes and deaths. It was a retrospective-prospective cohort study based on two cohorts of patients. The entecavir cohort included consecutive CHB patients who had received entecavir 0.5 mg/day for at least 12 months. The historical control cohort included untreated patients recruited since 1997 who underwent routine clinical care. The primary outcome was the 5-year cumulative probability of hepatic events, defined as any cirrhotic complications, hepatocellular carcinoma (HCC), and/or liver-related mortality. A total of 1,446 entecavir-treated patients (72% men; age, 51 ± 12 years; follow-up, 36 ± 13 months) and 424 treatment-naïve patients (65% men; age, 41 ± 13 years; follow-up, 114 ± 31 months) were studied. Overall, there was no difference in hepatic events between the entecavir and control cohorts. Among patients with liver cirrhosis (482 entecavir-treated, 69 treatment-naïve), entecavir-treated patients had reduced risks of all clinical outcomes when compared with treatment-naïve patients with cirrhosis after adjusted for model for end-stage liver disease score: hepatic events (hazard ratio [HR], 0.51; 95% confidence interval [CI], 0.34-0.78; P = 0.002), HCC (HR, 0.55; 95% CI, 0.31-0.99; P = 0.049), liver-related mortality (HR, 0.26; 95% CI, 0.13-0.55; P < 0.001), and all-cause mortality (HR, 0.34; 95% CI, 0.18-0.62; P < 0.001). Entecavir-treated patients with cirrhosis who failed to achieve undetectable hepatitis B virus DNA (105/482 [22%]) had comparable risk of hepatic events as the untreated patients.
  
  
  CONCLUSIONS
  Entecavir therapy reduces the risks of hepatic events, HCC, liver-related and all-cause mortality of CHB patients with liver cirrhosis in 5 years, particularly among those who had maintained viral suppression.
authors: Institute of Digestive Disease, the Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China.
authors: Grace Lai-Hung
authors: GL
authors: Wong
authors: Henry Lik-Yuen
authors: HL
authors: Chan
authors: Christy Wing-Hin
authors: CW
authors: Mak
authors: Stanley King-Yeung
authors: SK
authors: Lee
authors: Zoe Man-Yi
authors: ZM
authors: Ip
authors: Andrew Ting-Ho
authors: AT
authors: Lam
authors: Henry Wing-Hang
authors: HW
authors: Iu
authors: Joyce May-Sum
authors: JM
authors: Leung
authors: Jennifer Wing-Yan
authors: JW
authors: Lai
authors: Angeline Oi-Shan
authors: AO
authors: Lo
authors: Hoi-Yun
authors: HY
authors: Chan
authors: Vincent Wai-Sun
authors: VW
authors: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000517:prevention & control; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology*; D008113:Liver Neoplasms / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; C413685:entecavir; D006147:Guanine