& Aims: Little is known about whether the antiviral agent entecavir is more effective than a less potent drug, lamivudine, in reducing the risk of death and hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB).
We performed a retrospective analysis of data from 5374 consecutive adult patients with CHB, treated with entecavir (n=2000) or lamivudine (n=3374) at a tertiary referral hospital in Seoul, Korea from November 1, 1999 through December 31, 2011. Data were collected from patients for up to 6 years and analyzed by multivariable Cox proportional hazards model for the entire cohort and for propensity score matched cohorts.
During the study period, 302 patients (5.6%) died, 169 (3.1%) received a liver transplant, and 525 (9.8%) developed HCC. Multivariable analyses showed that compared with lamivudine, entecavir therapy was associated with a significantly lower risk of death or transplantation (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.38–0.64), but a similar risk of HCC (HR, 1.08; 95% CI, 0.87–1.34). In the 1792 overall propensity-matched pairs, entecavir was again associated with a significantly lower risk of death or transplantation (HR, 0.49; 95% CI, 0.37–0.64) and a similar risk of HCC (HR, 1.01; 95% CI, 0.80–1.27). Entecavir also reduced risk of death or transplantation, compared with lamivudine, in 860 pairs of patients with cirrhosis (HR, 0.42; 95% CI, 0.31–0.57) but there were no differences in risk for HCC (HR, 1.00; 95% CI, 0.78–1.28). However, entecavir and lamivudine did not have significantly different effects on clinical outcome in 878 pairs of patients without cirrhosis.
In a retrospective study of 5374 patients with chronic hepatitis B virus infection, entecavir therapy was associated with a significantly lower risk of death or transplantation than lamivudine. However, the drugs did not have different effects on HCC risk.
The only way to reduce risk significantly is hbsag clearance with or without seroconversion to anti-hbs. Nowadays the only way to obtain that status is through interferon therapy but unfortunately inf doesn't work for everyone.
Andrey is correct peg add on is the best solutions and peg is even active on liver tumors so in case of hbsag clearance its effect is very considerable
peg is a tumor therapy for melanoma and other tumors too
it is also interesting to see how nagalase goes once hbsag is cleared, my guess is that presence of nagalase during hbv infection is one of the main tumors effectors, afterall if immune system is fully functional we can have all the hcc we want in the liver...that it will get cleared by the immune system
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