Nucleoside analogues improve the short-term and long-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure
Hepatitis B virus (HBV) infection is a major public health problem, and HBV-related acute-on-chronic liver failure (ACLF) has an extremely poor prognosis. There is no standard approach for managing ACLF. Nucleos(t)ide analogue has been proven effective in suppressing viral replication, improving his...
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| Published in | Clinical and experimental medicine Vol. 12; no. 3; pp. 159 - 164 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Milan
Springer Milan
01.09.2012
Springer Nature B.V |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1591-8890 1591-9528 1591-9528 |
| DOI | 10.1007/s10238-011-0160-7 |
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| Abstract | Hepatitis B virus (HBV) infection is a major public health problem, and HBV-related acute-on-chronic liver failure (ACLF) has an extremely poor prognosis. There is no standard approach for managing ACLF. Nucleos(t)ide analogue has been proven effective in suppressing viral replication, improving histology and biochemical, and decreasing the inflammatory response in patients with chronic hepatitis B. This study was designed to evaluate the short-term and long-term efficacy of nucleoside analogue treatment of patients with HBV-related ACLF. One hundred and six consecutive subjects were recruited from 2,308 patients with elevated alanine aminotransferase activity. Forty-two patients were treated with 0.5 mg entecavir (ETV) daily (ETV group); 30 patients received 100 mg lamivudine (LAM) daily (LAM group); 34 patients did not take any nucleos(t)ide analogues (non-NAs group). All eligible patients were given standard medical treatment. All the patients were followed up until death or until October 2010. The HBV DNA levels and the short-term and long-term efficacy of the drugs were evaluated. After 3 weeks of nucleoside analogue treatment and/or supportive therapy, HBV DNA levels were decreased when compared with the baseline level in the ETV group (7.04 ± 1.58 log
10
IU/mL vs. 4.03 ± 2.04 log
10
IU/mL,
P
= 0.001), the LAM group (7.25 ± 0.89 log
10
IU/mL vs. 4.33 ± 2.48 log
10
IU/mL,
P
= 0.01), and the non-NAs group (5.73 ± 0.96 log
10
IU/mL vs. 4.21 ± 1.47 log
10
IU/mL,
P
= 0.01). The ETV and LAM groups showed a similar accumulative mortality in the first 3 months of treatment (33.3% vs. 40%, χ
2
= 0.568,
P
= 0.374). The non-NAs group had a significantly high mortality, compared with the ETV group (64.7% vs. 33.3%, χ
2
= 7.163,
P
= 0.007), the LAM group (64.7% vs. 40%, χ
2
= 3.906,
P
= 0.042), and the nucleoside analogue group (ETV group + LAM group) (64.7% vs. 36.2%, χ
2
= 7.443,
P
= 0.006). All the 56 patients survived were followed up to October 2010. The median follow-up period was 7.3 months. Recurrence was observed in a total of 6 patients (10.72%), of whom 4 patients (33.33%) were from the non-NAs group, 2 (11.11%) from the LAM group after cessation LAM therapy by patients himself, and 0 from the ETV group (
P
= 0.003). Nucleoside analogue may improve the short-term and long-term prognosis of patients with HBV-related ACLF. |
|---|---|
| AbstractList | Hepatitis B virus (HBV) infection is a major public health problem, and HBV-related acute-on-chronic liver failure (ACLF) has an extremely poor prognosis. There is no standard approach for managing ACLF. Nucleos(t)ide analogue has been proven effective in suppressing viral replication, improving histology and biochemical, and decreasing the inflammatory response in patients with chronic hepatitis B. This study was designed to evaluate the short-term and long-term efficacy of nucleoside analogue treatment of patients with HBV-related ACLF. One hundred and six consecutive subjects were recruited from 2,308 patients with elevated alanine aminotransferase activity. Forty-two patients were treated with 0.5 mg entecavir (ETV) daily (ETV group); 30 patients received 100 mg lamivudine (LAM) daily (LAM group); 34 patients did not take any nucleos(t)ide analogues (non-NAs group). All eligible patients were given standard medical treatment. All the patients were followed up until death or until October 2010. The HBV DNA levels and the short-term and long-term efficacy of the drugs were evaluated. After 3 weeks of nucleoside analogue treatment and/or supportive therapy, HBV DNA levels were decreased when compared with the baseline level in the ETV group (7.04 ± 1.58 log
10
IU/mL vs. 4.03 ± 2.04 log
10
IU/mL,
P
= 0.001), the LAM group (7.25 ± 0.89 log
10
IU/mL vs. 4.33 ± 2.48 log
10
IU/mL,
P
= 0.01), and the non-NAs group (5.73 ± 0.96 log
10
IU/mL vs. 4.21 ± 1.47 log
10
IU/mL,
P
= 0.01). The ETV and LAM groups showed a similar accumulative mortality in the first 3 months of treatment (33.3% vs. 40%, χ
2
= 0.568,
P
= 0.374). The non-NAs group had a significantly high mortality, compared with the ETV group (64.7% vs. 33.3%, χ
2
= 7.163,
P
= 0.007), the LAM group (64.7% vs. 40%, χ
2
= 3.906,
P
= 0.042), and the nucleoside analogue group (ETV group + LAM group) (64.7% vs. 36.2%, χ
2
= 7.443,
P
= 0.006). All the 56 patients survived were followed up to October 2010. The median follow-up period was 7.3 months. Recurrence was observed in a total of 6 patients (10.72%), of whom 4 patients (33.33%) were from the non-NAs group, 2 (11.11%) from the LAM group after cessation LAM therapy by patients himself, and 0 from the ETV group (
P
= 0.003). Nucleoside analogue may improve the short-term and long-term prognosis of patients with HBV-related ACLF. Hepatitis B virus (HBV) infection is a major public health problem, and HBV-related acute-on-chronic liver failure (ACLF) has an extremely poor prognosis. There is no standard approach for managing ACLF. Nucleos(t)ide analogue has been proven effective in suppressing viral replication, improving histology and biochemical, and decreasing the inflammatory response in patients with chronic hepatitis B. This study was designed to evaluate the short-term and long-term efficacy of nucleoside analogue treatment of patients with HBV-related ACLF. One hundred and six consecutive subjects were recruited from 2,308 patients with elevated alanine aminotransferase activity. Forty-two patients were treated with 0.5 mg entecavir (ETV) daily (ETV group); 30 patients received 100 mg lamivudine (LAM) daily (LAM group); 34 patients did not take any nucleos(t)ide analogues (non-NAs group). All eligible patients were given standard medical treatment. All the patients were followed up until death or until October 2010. The HBV DNA levels and the short-term and long-term efficacy of the drugs were evaluated. After 3 weeks of nucleoside analogue treatment and/or supportive therapy, HBV DNA levels were decreased when compared with the baseline level in the ETV group (7.04 ± 1.58 log(10) IU/mL vs. 4.03 ± 2.04 log(10) IU/mL, P = 0.001), the LAM group (7.25 ± 0.89 log(10) IU/mL vs. 4.33 ± 2.48 log(10) IU/mL, P = 0.01), and the non-NAs group (5.73 ± 0.96 log(10) IU/mL vs. 4.21 ± 1.47 log(10) IU/mL, P = 0.01). The ETV and LAM groups showed a similar accumulative mortality in the first 3 months of treatment (33.3% vs. 40%, χ(2) = 0.568, P = 0.374). The non-NAs group had a significantly high mortality, compared with the ETV group (64.7% vs. 33.3%, χ(2) = 7.163, P = 0.007), the LAM group (64.7% vs. 40%, χ(2) = 3.906, P = 0.042), and the nucleoside analogue group (ETV group + LAM group) (64.7% vs. 36.2%, χ(2) = 7.443, P = 0.006). All the 56 patients survived were followed up to October 2010. The median follow-up period was 7.3 months. Recurrence was observed in a total of 6 patients (10.72%), of whom 4 patients (33.33%) were from the non-NAs group, 2 (11.11%) from the LAM group after cessation LAM therapy by patients himself, and 0 from the ETV group (P = 0.003). Nucleoside analogue may improve the short-term and long-term prognosis of patients with HBV-related ACLF.Hepatitis B virus (HBV) infection is a major public health problem, and HBV-related acute-on-chronic liver failure (ACLF) has an extremely poor prognosis. There is no standard approach for managing ACLF. Nucleos(t)ide analogue has been proven effective in suppressing viral replication, improving histology and biochemical, and decreasing the inflammatory response in patients with chronic hepatitis B. This study was designed to evaluate the short-term and long-term efficacy of nucleoside analogue treatment of patients with HBV-related ACLF. One hundred and six consecutive subjects were recruited from 2,308 patients with elevated alanine aminotransferase activity. Forty-two patients were treated with 0.5 mg entecavir (ETV) daily (ETV group); 30 patients received 100 mg lamivudine (LAM) daily (LAM group); 34 patients did not take any nucleos(t)ide analogues (non-NAs group). All eligible patients were given standard medical treatment. All the patients were followed up until death or until October 2010. The HBV DNA levels and the short-term and long-term efficacy of the drugs were evaluated. After 3 weeks of nucleoside analogue treatment and/or supportive therapy, HBV DNA levels were decreased when compared with the baseline level in the ETV group (7.04 ± 1.58 log(10) IU/mL vs. 4.03 ± 2.04 log(10) IU/mL, P = 0.001), the LAM group (7.25 ± 0.89 log(10) IU/mL vs. 4.33 ± 2.48 log(10) IU/mL, P = 0.01), and the non-NAs group (5.73 ± 0.96 log(10) IU/mL vs. 4.21 ± 1.47 log(10) IU/mL, P = 0.01). The ETV and LAM groups showed a similar accumulative mortality in the first 3 months of treatment (33.3% vs. 40%, χ(2) = 0.568, P = 0.374). The non-NAs group had a significantly high mortality, compared with the ETV group (64.7% vs. 33.3%, χ(2) = 7.163, P = 0.007), the LAM group (64.7% vs. 40%, χ(2) = 3.906, P = 0.042), and the nucleoside analogue group (ETV group + LAM group) (64.7% vs. 36.2%, χ(2) = 7.443, P = 0.006). All the 56 patients survived were followed up to October 2010. The median follow-up period was 7.3 months. Recurrence was observed in a total of 6 patients (10.72%), of whom 4 patients (33.33%) were from the non-NAs group, 2 (11.11%) from the LAM group after cessation LAM therapy by patients himself, and 0 from the ETV group (P = 0.003). Nucleoside analogue may improve the short-term and long-term prognosis of patients with HBV-related ACLF. Hepatitis B virus (HBV) infection is a major public health problem, and HBV-related acute-on-chronic liver failure (ACLF) has an extremely poor prognosis. There is no standard approach for managing ACLF. Nucleos(t)ide analogue has been proven effective in suppressing viral replication, improving histology and biochemical, and decreasing the inflammatory response in patients with chronic hepatitis B. This study was designed to evaluate the short-term and long-term efficacy of nucleoside analogue treatment of patients with HBV-related ACLF. One hundred and six consecutive subjects were recruited from 2,308 patients with elevated alanine aminotransferase activity. Forty-two patients were treated with 0.5 mg entecavir (ETV) daily (ETV group); 30 patients received 100 mg lamivudine (LAM) daily (LAM group); 34 patients did not take any nucleos(t)ide analogues (non-NAs group). All eligible patients were given standard medical treatment. All the patients were followed up until death or until October 2010. The HBV DNA levels and the short-term and long-term efficacy of the drugs were evaluated. After 3 weeks of nucleoside analogue treatment and/or supportive therapy, HBV DNA levels were decreased when compared with the baseline level in the ETV group (7.04 ± 1.58 log^sub 10^ IU/mL vs. 4.03 ± 2.04 log^sub 10^ IU/mL, P = 0.001), the LAM group (7.25 ± 0.89 log^sub 10^ IU/mL vs. 4.33 ± 2.48 log^sub 10^ IU/mL, P = 0.01), and the non-NAs group (5.73 ± 0.96 log^sub 10^ IU/mL vs. 4.21 ± 1.47 log^sub 10^ IU/mL, P = 0.01). The ETV and LAM groups showed a similar accumulative mortality in the first 3 months of treatment (33.3% vs. 40%, χ^sup 2^ = 0.568, P = 0.374). The non-NAs group had a significantly high mortality, compared with the ETV group (64.7% vs. 33.3%, χ^sup 2^ = 7.163, P = 0.007), the LAM group (64.7% vs. 40%, χ^sup 2^ = 3.906, P = 0.042), and the nucleoside analogue group (ETV group + LAM group) (64.7% vs. 36.2%, χ^sup 2^ = 7.443, P = 0.006). All the 56 patients survived were followed up to October 2010. The median follow-up period was 7.3 months. Recurrence was observed in a total of 6 patients (10.72%), of whom 4 patients (33.33%) were from the non-NAs group, 2 (11.11%) from the LAM group after cessation LAM therapy by patients himself, and 0 from the ETV group (P = 0.003). Nucleoside analogue may improve the short-term and long-term prognosis of patients with HBV-related ACLF.[PUBLICATION ABSTRACT] Hepatitis B virus (HBV) infection is a major public health problem, and HBV-related acute-on-chronic liver failure (ACLF) has an extremely poor prognosis. There is no standard approach for managing ACLF. Nucleos(t)ide analogue has been proven effective in suppressing viral replication, improving histology and biochemical, and decreasing the inflammatory response in patients with chronic hepatitis B. This study was designed to evaluate the short-term and long-term efficacy of nucleoside analogue treatment of patients with HBV-related ACLF. One hundred and six consecutive subjects were recruited from 2,308 patients with elevated alanine aminotransferase activity. Forty-two patients were treated with 0.5 mg entecavir (ETV) daily (ETV group); 30 patients received 100 mg lamivudine (LAM) daily (LAM group); 34 patients did not take any nucleos(t)ide analogues (non-NAs group). All eligible patients were given standard medical treatment. All the patients were followed up until death or until October 2010. The HBV DNA levels and the short-term and long-term efficacy of the drugs were evaluated. After 3 weeks of nucleoside analogue treatment and/or supportive therapy, HBV DNA levels were decreased when compared with the baseline level in the ETV group (7.04 ± 1.58 log(10) IU/mL vs. 4.03 ± 2.04 log(10) IU/mL, P = 0.001), the LAM group (7.25 ± 0.89 log(10) IU/mL vs. 4.33 ± 2.48 log(10) IU/mL, P = 0.01), and the non-NAs group (5.73 ± 0.96 log(10) IU/mL vs. 4.21 ± 1.47 log(10) IU/mL, P = 0.01). The ETV and LAM groups showed a similar accumulative mortality in the first 3 months of treatment (33.3% vs. 40%, χ(2) = 0.568, P = 0.374). The non-NAs group had a significantly high mortality, compared with the ETV group (64.7% vs. 33.3%, χ(2) = 7.163, P = 0.007), the LAM group (64.7% vs. 40%, χ(2) = 3.906, P = 0.042), and the nucleoside analogue group (ETV group + LAM group) (64.7% vs. 36.2%, χ(2) = 7.443, P = 0.006). All the 56 patients survived were followed up to October 2010. The median follow-up period was 7.3 months. Recurrence was observed in a total of 6 patients (10.72%), of whom 4 patients (33.33%) were from the non-NAs group, 2 (11.11%) from the LAM group after cessation LAM therapy by patients himself, and 0 from the ETV group (P = 0.003). Nucleoside analogue may improve the short-term and long-term prognosis of patients with HBV-related ACLF. Hepatitis B virus (HBV) infection is a major public health problem, and HBV-related acute-on-chronic liver failure (ACLF) has an extremely poor prognosis. There is no standard approach for managing ACLF. Nucleos(t)ide analogue has been proven effective in suppressing viral replication, improving histology and biochemical, and decreasing the inflammatory response in patients with chronic hepatitis B. This study was designed to evaluate the short-term and long-term efficacy of nucleoside analogue treatment of patients with HBV-related ACLF. One hundred and six consecutive subjects were recruited from 2,308 patients with elevated alanine aminotransferase activity. Forty-two patients were treated with 0.5 mg entecavir (ETV) daily (ETV group); 30 patients received 100 mg lamivudine (LAM) daily (LAM group); 34 patients did not take any nucleos(t)ide analogues (non-NAs group). All eligible patients were given standard medical treatment. All the patients were followed up until death or until October 2010. The HBV DNA levels and the short-term and long-term efficacy of the drugs were evaluated. After 3 weeks of nucleoside analogue treatment and/or supportive therapy, HBV DNA levels were decreased when compared with the baseline level in the ETV group (7.04 plus or minus 1.58 log sub(10) IU/mL vs. 4.03 plus or minus 2.04 log sub(10) IU/mL, P = 0.001), the LAM group (7.25 plus or minus 0.89 log sub(10) IU/mL vs. 4.33 plus or minus 2.48 log sub(10) IU/mL, P = 0.01), and the non-NAs group (5.73 plus or minus 0.96 log sub(10) IU/mL vs. 4.21 plus or minus 1.47 log sub(10) IU/mL, P = 0.01). The ETV and LAM groups showed a similar accumulative mortality in the first 3 months of treatment (33.3% vs. 40%, chi super(2) = 0.568, P = 0.374). The non-NAs group had a significantly high mortality, compared with the ETV group (64.7% vs. 33.3%, chi super(2) = 7.163, P = 0.007), the LAM group (64.7% vs. 40%, chi super(2) = 3.906, P = 0.042), and the nucleoside analogue group (ETV group + LAM group) (64.7% vs. 36.2%, chi super(2) = 7.443, P = 0.006). All the 56 patients survived were followed up to October 2010. The median follow-up period was 7.3 months. Recurrence was observed in a total of 6 patients (10.72%), of whom 4 patients (33.33%) were from the non-NAs group, 2 (11.11%) from the LAM group after cessation LAM therapy by patients himself, and 0 from the ETV group (P = 0.003). Nucleoside analogue may improve the short-term and long-term prognosis of patients with HBV-related ACLF. |
| Author | Wang, Ke Yan, Zhi Chen, Tianyan Zhao, Yingren He, Yingli Liu, Hongli Zhang, Shuling Liu, Xiaojing |
| Author_xml | – sequence: 1 givenname: Tianyan surname: Chen fullname: Chen, Tianyan organization: Department of Infectious Diseases, First Affiliated Hospital of Medical College, Xi’an Jiaotong University – sequence: 2 givenname: Yingli surname: He fullname: He, Yingli email: Yhe30@emory.edu organization: Department of Infectious Diseases, First Affiliated Hospital of Medical College, Xi’an Jiaotong University – sequence: 3 givenname: Xiaojing surname: Liu fullname: Liu, Xiaojing organization: Department of Infectious Diseases, First Affiliated Hospital of Medical College, Xi’an Jiaotong University – sequence: 4 givenname: Zhi surname: Yan fullname: Yan, Zhi organization: Hepatitis Institution, First Affiliated Hospital of Medical College, Xi’an Jiaotong University – sequence: 5 givenname: Ke surname: Wang fullname: Wang, Ke organization: Hepatitis Institution, First Affiliated Hospital of Medical College, Xi’an Jiaotong University – sequence: 6 givenname: Hongli surname: Liu fullname: Liu, Hongli organization: Hepatitis Institution, First Affiliated Hospital of Medical College, Xi’an Jiaotong University – sequence: 7 givenname: Shuling surname: Zhang fullname: Zhang, Shuling organization: Department of Infectious Diseases, First Affiliated Hospital of Medical College, Xi’an Jiaotong University – sequence: 8 givenname: Yingren surname: Zhao fullname: Zhao, Yingren email: zyr@mail.xjtu.edu.cn organization: Department of Infectious Diseases, First Affiliated Hospital of Medical College, Xi’an Jiaotong University |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22002708$$D View this record in MEDLINE/PubMed |
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| CODEN | CEMLBA |
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| DOI | 10.1007/s10238-011-0160-7 |
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| Keywords | Enticavir Lamivudine Acute-on-chronic liver failure Hepatitis B virus |
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