title: Predictors associated with treatment initiation and switch in a real-world chronic hepatitis B population from five European countries.
abstract: In Europe, healthcare systems differ between countries and different factors may influence Chronic hepatitis B (CHB) treatment choices in different counties. This analysis from a prospective, longitudinal, non-interventional study in five EU countries aimed to explore determinants associated with treatment initiation or switch in patients with CHB. A total of 1267 adult patients with compensated CHB in Germany, France, Poland, Romania and Turkey were prospectively followed for up to 2 years (March 2008-December 2010). Determinants of treatment initiation or switch were analysed using multivariate Cox proportional hazards regression. Median time since CHB diagnosis was 2.6 (0-37.7) years. Among 646 treatment-naïve patients, the probability of treatment initiation during follow-up was higher: in Germany (P = 0.0006), Poland (P < 0.0001) and Romania (P = 0.0004) compared with Turkey; in patients with alanine transaminase (ALT) 1-2 × upper limit of normal (ULN) (P = 0.0580) or >2 × ULN (P = 0.0523) compared with ALT ≤ 1 × ULN; and in patients with hepatitis B virus (HBV) DNA ≥ 2000 IU/mL (P < 0.0001) compared with HBV DNA <2000 IU/mL or undetectable. Among 567 treated patients, 87 switched treatment during follow-up. The probability of treatment switch was higher: in France (P = 0.0029), Germany (P = 0.0078) and Poland (P = 0.0329) compared with Turkey; and in patients with HBV DNA <2000 (P < 0.0001) or ≥ 2000 IU/mL (P < 0.0001), compared with undetectable. Viral load and ALT level were identified as the major drivers of treatment initiation. HBV DNA level was also a significant determinant of treatment switch. Results were statistically different across EU countries.
authors: Medical School Samsun, Ondokuz Mayis University, Samsun, Turkey.
authors: H
authors: H
authors: Leblebicioglu
authors: V
authors: V
authors: Arama
authors: X
authors: X
authors: Causse
authors: P
authors: P
authors: Marcellin
authors: R
authors: R
authors: Ozaras
authors: B
authors: B
authors: Postawa-Klozinska
authors: K
authors: K
authors: Simon
authors: A I
authors: AI
authors: Suceveanu
authors: M
authors: M
authors: Wiese
authors: S
authors: S
authors: Zeuzem
authors: I
authors: I
authors: Klauck
authors: E
authors: E
authors: Morais
authors: S
authors: S
authors: Bjork
authors: B
authors: B
authors: Lescrauwaet
authors: D
authors: D
authors: Kamar
authors: J P
authors: JP
authors: Zarski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use*; D005060:Europe; D005260:Female; D005843:Geography; D019694:Hepatitis B, Chronic / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000410:Alanine Transaminase
keywords: adefovir; antiviral treatment; chronic hepatitis B; entecavir; lamivudine; tenofovir