VIROLOGICAL RESPONSE DOES NOT LOWER LIVER DISEASE PROGRESSION AMONG
CHRONIC HEPATITIS B CIRRHOTIC PATIENTS TREATED WITH LONG-TERM
/P.S. Tan^1 , Y.Y. Dan^1,2 , Y.M. Lee^1 , K. Lim^1 , G.H. Lee^1 , H.C.
Low^1 , M.A. Thwin^1 , *S.G. Lim*^1,2 */^1 Gastroenterology &
Hepatology, National University Health System, ^2 Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore.
*Background: *A large number of chronic hepatitis B patients with
cirrhosis are on long-term nucleos(t)ide-analogue therapy. The impact of
anti-viral treatment on liver disease progression among these cirrhotics
remains to be characterized.
*Method: *CHB cirrhotics treated with long-term LAM-ADV combination
therapy or ETV monotherapy in our center were enrolled and followed for
outcomes. Liver disease progression was defined as liver decompensation,
development of hepatocellular carcinoma and death. Cumulative
probability of virological and clinical outcomes was evaluated by
Kaplan-Meier analysis, log-rank test and Cox-regression analysis.
*Results: *A total of 264 cirrhotics (compensated disease 87.5%)
fulfilled enrollment criteria, of which 143 and 121 were treated with
LAM-ADV and ETV respectively. In LAM-ADV group, 57 (39.9%) were
HBeAg-positive, mean HBV-DNA was 5.8 (5.5-6.1) log IU/mL, mean LAM-ADV
duration was 41.4 (14.5-68.3) months and mean follow-up was 72.8
(31.5-114.1) months. In ETV group, 48 (39.7%) were HBeAg-positive, mean
HBV-DNA was 4.4 (4.1-4.7) log IU/mL, mean ETV duration was 33.3
(15.2-51.4) months and mean follow-up was 45.7 (16.8-74.6) months. Among
LAM-ADV group, cumulative probability of (a) virological response were
59.9%, 92.2%, 95.6% and (b) liver disease progression was 4.5%, 17.6%,
32.9%, at year 1, 3 and 5 respectively. Among ETV group, cumulative
probability of (a) virological response was 74.5%, 94.8%, 100% and (b)
liver disease progression was 7.8%, 12.5%, 17.7% at year 1, 3 and 5
respectively. The probability of liver disease progression was not
influenced by virological response (p=0.174). When stratified by
treatment group, virological response again did not impact on the
cumulative probability of liver disease progression (LAM-ADV group:
p=0.173 and ETV group: p=0.433). Among virological responders, there was
also no difference between LAM-ADV combination and ETV monotherapy group
(p=0.199). Cox-regression showed baseline decompensated disease status
was a significant predictor of disease progression (HR 4.96; 95%CI
2.61-9.44; p< 0.01) whereas virological response had no impact (p=0.196).
*Conclusion: *Among cirrhotics treated with long-term LAM-ADV
combination therapy or ETV monotherapy, despite the excellent anti-viral
efficacy, there was still significant probability of liver disease
progression. LAM-ADV combination or ETV-monotherapy induced virological
response did not lower the probability of liver disease progression in
*Seng Gee Lim, National University Health System , Singapore , Singapore
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