Early on-treatment LSM reliably predicts liver-related events in CHB patients with significant fibrosis and cirrhosis.

BACKGROUND AND AIMS: Evidence comparing longitudinal liver stiffness measurements (LSMs) dynamics to on-treatment LSM for predicting clinical outcomes in patients receiving etiology therapy is limited. This study aimed to assess the prognostic value of on-treatment LSM in patients with chronic hepatitis B (CHB) receiving antiviral therapy.

APPROACH AND

RESULTS

This prospective cohort included patients with CHB and significant fibrosis or cirrhosis. Liver-related events (LREs) were defined as hepatic decompensation, liver transplantation, or liver-related death. The association between LREs and baseline, on-treatment, and dynamic changes in LSM was analyzed. A total of 1116 patients with CHB, including 875 (78.4%) diagnosed with cirrhosis, were followed for a median of 7.5 (2.5-9.5) years. On-treatment LSM was the most reliable predictor of 3-year and 5-year outcomes (AUROC: 0.72-0.78) after 1-3 years of antiviral therapy, outperforming baseline LSM (AUROC: 0.59-0.65) and LSM changes (AUROC: 0.42-0.65).Patients with LSM <10 kPa at 1, 2, or 3 years of antiviral therapy have a much lower risk of LREs, with a 5-year cumulative incidence of 2.2%, 2.6%, and 2.7%, respectively. This finding held true in the cirrhosis subgroup, in the validation cohort, and for predicting decompensations alone. Notably, patients with on-treatment LSM <10 kPa showed better restoration of lobular architecture assessed by liver biopsies.

CONCLUSIONS

On-treatment LSM measured 1-3 years after antiviral therapy offers superior predictive accuracy for LREs compared with baseline or LSM changes, with LSM <10 kPa indicating a significantly lower risk, likely due to improved lobular architecture.