Korean J Gastroenterol.  2012 Mar;59(3):224-231. 10.4166/kjg.2012.59.3.224.

Entecavir Therapy for Patients with Hepatitis B Virus-related Decompensated Cirrhosis

• Kim IS
• Mun JI
• Koo JH
• Kang CJ
• Bak JK
• Cheong JY
• Cho SW

• KMID: 1245207
• DOI: http://doi.org/10.4166/kjg.2012.59.3.224

Abstract

BACKGROUND/AIMS
Entecavie (ETV) has a potent antiviral effect and low rates of resistance in hepatitis B virus (HBV) and is the first-line monotherapy in patients with HBV-related decompensated cirrhosis. We evaluated the efficacy of 12 months treatment with ETV and tried to determine predictive factors of response.
METHODS
Forty-five consecutive decompensated cirrhotic patients who received ETV (0.5 mg/day) for more than six months were included. All patients were positive for HBV DNA, and the Child-Turcotte-Pugh (CTP) scores were over 8 point. Seventeen patients were HBeAg-positive. CTP score, model for end-stage liver disease (MELD) score, serum markers of liver function and HBV DNA were assessed every 3 months.
RESULTS
ETV treatment for 12 months resulted in improvement of CTP and MELD scores. Pre-treatment mean CTP and MELD score were decreased from 10.1 (+/-2.0) and 13.48 (+/-4.05) to 7.24 (+/-2.0) and 9.68 (+/-4.85) at 12 months, respectively. The 1-year cumulative rates of HBV DNA negativity and HBeAg loss were 88.9% and 52.9%, respectively, by intention-to-treat analysis. Thirty-two (71.1%) showed improvement in CTP score. Eleven patients did not show change, and 2 patients got worse. The AST/ALT, albumin, bilrubin, prothrombin time were significantly normalized within six months. The good responder group had high level of prothrombin time than the poor responder group (p=0.004).
CONCLUSIONS
Our result shows that entecavir can improve liver function in about 70% of patients with HBV related decompensated liver cirrhosis. INR may be a predictive factor of good response with entecavir in these patients.

Keyword

Entecavir; Liver cirrhosis; Hepatitis B virus

MeSH Terms

Adult
Aged
Alanine Transaminase/blood
Antiviral Agents/*therapeutic use
Bilirubin/blood
DNA, Viral/analysis
Drug Administration Schedule
Female
Guanine/*analogs & derivatives/therapeutic use
Hepatitis B e Antigens/blood
Hepatitis B virus/*genetics
Hepatitis B, Chronic/complications/*drug therapy
Humans
Liver Cirrhosis/*etiology
Male
Middle Aged
Prothrombin Time
Serum Albumin/analysis
Severity of Illness Index

Figure

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  Fig. 1 Changes of ALT, albumin, bilirubin, and prothrombin time during entecavir treatment.

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  Fig. 2 Changes of Child-Turcotte-Pugh (CTP) score and model for end stage liver disease (MELD) score during entecavir therapy.

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  Fig. 3 Clinical outcome of 45 patients treated with entecavir therapy.

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