The impact of long-term potent antiviral therapy on the natural course of disease in patients with hepatitis B virus-related cirrhosis.

BACKGROUND AND AIM: The present study compared the long-term efficacy of weak and potent antiviral treatments in patients with hepatitis B virus (HBV)-related cirrhosis.

MATERIALS AND

METHODS

A total of 120 patients with HBV-related cirrhosis were enrolled. The primary outcome measure was viral suppression. A secondary outcome measure was to determine the development of decompensation or hepatocellular carcinoma (HCC).

RESULTS

The virological response (VR) was significantly better in patients treated with potent antiviral agents than in those treated with weaker antiviral agents over time (p<0.001). With intention-to-treat, the VR after 1 year, 2 years, 3 years, and 4 years of potent antiviral treatment was 69.7%, 77.0%, 82.2%, and 81.2%, respectively, while the VR with weak antiviral therapies was 50.0%, 41.6%, 37.5%, and 37.5%. HBeAg (Hepatitis B e-Antigen) loss was achieved in 30.4% of HBeAg-positive patients. None of the patients had experienced HBsAg loss while on antiviral treatment. New HCC developed in 10 patients. The cumulative probability of the development of HCC was 2.6% at 1 year, 6.8% at 2 years, and 8.7% at 3 and 5 years of antiviral therapy. MELD scores among patients treated with potent antiviral treatment significantly improved from baseline to week 60 (p=0.006). Antiviral therapies were well tolerated.

CONCLUSION

Potent antiviral treatment effectively maintained VR in the long-term follow-up of patients with HBV-related cirrhosis. HCC may still develop, albeit at a lower rate in these patients.