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Article Dans Une Revue Journal of Gastroenterology and Hepatology Année : 2016

Flares during long-term entecavir therapy in chronic hepatitis B

H. Chi
  • Fonction : Auteur
P. Arends
  • Fonction : Auteur
J.G. Reijnders
  • Fonction : Auteur
I. Carey
  • Fonction : Auteur
A. Brown
M. Fasano
  • Fonction : Auteur
D. Mutimer
  • Fonction : Auteur
K. Deterding
  • Fonction : Auteur
Y.H. Oo
  • Fonction : Auteur
J. Petersen
  • Fonction : Auteur
Bommel F. Van
  • Fonction : Auteur
R.J. De Knegt
  • Fonction : Auteur
T.A. Santantonio
  • Fonction : Auteur
T.M. Welzel
  • Fonction : Auteur
H. Wedemeyer
  • Fonction : Auteur
M. Buti
  • Fonction : Auteur
F. Zoulim
B.E. Hansen
  • Fonction : Auteur
H.L. Janssen
  • Fonction : Auteur

Résumé

BACKGROUND AND AIM: The incidence and consequences of flares during first-line nucleos(t)ide analogue therapy are largely unknown. We aimed to investigate the incidence and outcome of alanine aminotransferase (ALT) flares during long-term entecavir (ETV) in chronic hepatitis B (CHB). METHODS: CHB patients treated with ETV monotherapy from 11 European centers were studied. Flare was defined as \textgreater 3x increase in ALT compared with baseline or lowest on-treatment level and an absolute ALT \textgreater 3x ULN. Flares were designated as host-induced (preceded by hepatitis B virus (HBV)-DNA decline), virus-induced (HBV-DNA increase), or indeterminate (stable HBV-DNA). RESULTS: Seven hundred and twenty-nine patients were treated with ETV for median of 3.5 years. Thirty patients developed a flare with cumulative incidence of 6.3% at year 5. Baseline hepatitis B e antigen (HBeAg)-positivity (HR 2.84; P = 0.005) and high HBV-DNA (Hazard ratio (HR) 1.30; P = 0.003) predicted flares. There were 12 (40%) host-induced, 7 (23%) virus-induced, and 11 (37%) indeterminate flares. Host-induced flares occurred earlier than virus-induced (median: 15 vs 83 weeks; P = 0.027) or indeterminate flares (15 vs 109 weeks; P = 0.011). Host-induced flares were associated with biochemical remission, and HBeAg (n = 3) and hepatitis B surface antigen (n = 2) seroconversions were exclusively observed among patients with these flares. Virus-induced flares were associated with ETV resistance (n = 2) and non-compliance (n = 1). CONCLUSION: The incidence of ALT flares during ETV was low in this real-life cohort. ETV can be safely continued in patients with host-induced flares. Treatment adherence and drug resistance must be assessed in patients with virus-induced flares

Dates et versions

hal-01792378 , version 1 (15-05-2018)

Identifiants

Citer

H. Chi, P. Arends, J.G. Reijnders, I. Carey, A. Brown, et al.. Flares during long-term entecavir therapy in chronic hepatitis B. Journal of Gastroenterology and Hepatology, 2016, 31 (11), pp.1882-1887. ⟨10.1111/jgh.13377⟩. ⟨hal-01792378⟩
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