Jang JW, et al. - Researchers ascertained if a maintained virologic response (MVR, defined as persistent undetectable hepatitis B virus {HBV} DNA during therapy) associated with short-term (6-month) and long-term (6–120 months) survival of patients with decompensated cirrhosis. They discovered baseline model for end-stage liver disease (MELD) score and MVR to entecavir or lamivudine to associate with short- and long-term transplant-free survival in a 10-year observation study of patients in Korea with HBV-related decompensated cirrhosis. The benefits of an MVR were maintained for up to 10 years even after decompensation, yet patients were still at risk for hepatocellular carcinoma (HCC).

Methods

• A 10-year observation analysis was performed using data from the Epidemiology and Natural History of Liver Cirrhosis study of patients with decompensated liver cirrhosis in Korea.
• Of the entire cohort (1,595 patients enlisted at onset of decompensation since 2005), the analysis contained 295 patients who immediately started treatment with entecavir (n=179) or lamivudine (n=116) after decompensation.
• Laboratory test results, data on HCC development, and Child-Turcotte-Pugh and model for end-stage liver disease (MELD) scores were collected.
• The mean follow-up time was 62.3±36.5 months.
• Time of liver transplant-free survival was the primary end-point.

Results

• Researchers reported that the median survival time was 7.7 years; 60.1% of patients survived for 5 years and 45.7% survived for 10 years without liver transplantation.
• In 116 patients (39.3%) MVR was observed; these patients had significantly longer times of transplant-free survival compared with patients without MVR.
• They observed that survival times related to the occurrence of hepatocellular carcinoma (HCC); survival of patients without HCC was excellent if they survived the first 6 months after initiation of antiviral therapy, while the survival rates of patients with HCC decreased persistently over time.
• It was noted that baseline MELD score above 20 and multiple complications were related to short-term mortality.
• The factor most strongly associated with long-term transplant-free survival was MVR.
• Significantly higher proportions of patients who received entecavir survived 10 years contrasted with patients who received lamivudine, yet no difference was seen among patients with MVRs.
• According to the findings obtained, patients with MVRs had significant improvement in hepatic function over time, but nonsignificant reductions in risk of HCC or HCC-related mortality.