Entecavir vs. lamivudine in chronic hepatitis B patients with severe acute exacerbation and hepatic decompensation

Chien Hung Chen, Chih Lang Lin, Tsung Hui Hu, Chao Hung Hung, Po Lin Tseng, Jing Houng Wang, Juan Yu Chang, Sheng Nan Lu, Rong Nan Chien, Chuan Mo Lee*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

46 Scopus citations

Abstract

Background & Aims We compared the mortality and treatment response between lamivudine (LAM) and entecavir (ETV) in chronic hepatitis B (CHB) patients with severe acute exacerbation and hepatic decompensation. Methods From 2003 to 2010 (the LAM group) and 2008 to 2010 (the ETV group), 215 and 107 consecutive CHB naïve patients with severe acute exacerbation and hepatic decompensation treated with LAM and ETV respectively, were recruited. Results At baseline, the LAM group had higher AST levels and end-stage liver disease (MELD) scores, and lower albumin levels than the ETV group. Univariate analysis showed that the LAM group had a higher rate of overall (p = 0.02) and liver-related mortality (p = 0.052) at week 24 than the ETV group, including in patients with acute-on-chronic liver failure. Multivariate analysis showed that MELD scores, ascites, and hepatic encephalopathy were independent factors for overall and liver-related mortality at week 24. ETV or LAM treatment was not an independent factor for mortality in all patients or patients with acute-on-chronic liver failure. The best cut-off value of MELD scores were 24 for 24-week liver-related mortality. The ETV group achieved better virological response (HBV DNA <300 copies/ml) than the LAM group at week 24 (p = 0.043) and 48 (p = 0.007). The T1753C/A mutation was also an independent predictor associated with overall and liver-related mortality at week 24. Conclusions The choice between ETV and LAM was not an independent factor for mortality in CHB patients with acute exacerbation and hepatic decompensation. Patients with ascites, hepatic encephalopathy, and MELD scores ≥24 were associated with poor outcome and should be considered for liver transplantation.

Original languageEnglish
Pages (from-to)1127-1134
Number of pages8
JournalJournal of Hepatology
Volume60
Issue number6
DOIs
StatePublished - 06 2014
Externally publishedYes

Keywords

  • Basal core promoter mutation
  • Hepatic encephalopathy
  • Hepatitis B virus
  • Liver-related mortality
  • MELD scores

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