Nucleos(t)ide analogue continuous therapy associated with reduced adverse outcomes of chronic hepatitis B
Nucleos(t)ide analogue continuous therapy associated with reduced adverse outcomes of chronic hepatitis B
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DOI：
10.1097/jcma.0000000000000247
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发表时间：
2020-02-01
影响因子：
3
通讯作者：
Wu, Jaw-Ching
中科院分区：
文献类型：
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作者：
Su, Chien-Wei;Wu, Chun-Ying;Wu, Jaw-Ching
背景：核苷（酸）类似物（NA）治疗可降低慢性B型肝炎病毒感染患者疾病进展的风险。然而，肝失代偿，肝功能衰竭和死亡率的风险后，NA therapeutic still unknown.Methods：在51，574例慢性肝炎B患者接受NA在台湾国民健康保险研究数据库中，我们确定了8,631例患者继续NA治疗（治疗队列）和8,631倾向评分匹配的患者谁停止NA治疗后，他们最初的1.5年治疗（停药队列）2003年10月1日至2011年12月31日。所有研究受试者从索引日期（即首次处方NA后1.5年的日期）开始随访，直至发生肝功能失代偿和肝功能衰竭、死亡或18个月随访期结束。（1.05%; 95%置信区间[CI]，0.81%-1.30% vs 2.13%; 95% CI，1.82%-2.45%; p < 0.001），肝衰竭（0.35%; 95% CI，0.21%-0.49% vs 0.63%; 95% CI，0.46%-0.80%; p = 0.008）和18个月随访期间的总体死亡率（1.67%; 1.37%-1.98% vs 2.44%; 95% CI，2.10%-2.77%; p < 0.001）。调整潜在混杂因素后，NA持续治疗与肝失代偿风险降低相关（风险比[HR]：0.47; 95% CI，0.36-0.62，p < 0.001），肝衰竭（HR：0.53; 95%CI，0.33-0.86，p = 0.01）和总体死亡率（HR：0.67; 95%CI，0.53-0.84，p = 0.001）。减少一个疾病进展和死亡率所需的数字是47。NA连续治疗的保护作用被发现在几乎所有subgroup.Conclusion：NA连续治疗与肝失代偿，肝功能衰竭，总死亡率的风险降低。
Background:Nucleos(t)ide analogue (NA) therapy reduces the risk of disease progression in chronic hepatitis B virus-infected patients. However, the risk of liver decompensation, hepatic failure, and mortality after discontinuation of NA therapy remains unknown.Methods:Among 51,574 chronic hepatitis B patients who received NAs in the Taiwan National Health Insurance Research Database, we identified 8,631 patients who continued NA therapy (treatment cohort) and 8,631 propensity-score matched patients who stopped NA therapy after their initial 1.5 years treatment (off-therapy cohort) between October 1, 2003 and December 31, 2011. All study subjects were followed up from the index date, that is, the date 1.5 years after the first prescription of NA, until development of liver decompensation and hepatic failure, death or end of 18-month follow-up period.Results:Treatment cohort had significantly lower risks of liver decompensation (1.05%; 95% confidence interval [CI], 0.81%-1.30% vs 2.13%; 95% CI, 1.82%-2.45%; p < 0.001), hepatic failure (0.35%; 95% CI, 0.21%-0.49% vs 0.63%; 95% CI, 0.46%-0.80%; p = 0.008) and overall mortality (1.67%; 1.37%-1.98% vs 2.44%; 95% CI, 2.10%-2.77%; p < 0.001) during the 18-month follow-up period. After adjusting for potential confounders, NA continuous therapy was associated with reduced risks of liver decompensation (hazard ratio [HR]: 0.47; 95% CI, 0.36-0.62, p < 0.001), hepatic failure (HR: 0.53; 95% CI, 0.33-0.86, p = 0.01) and overall mortality (HR: 0.67; 95% CI, 0.53-0.84, p = 0.001). The number needed to reduce one less disease progression and mortality was 47. The protective effect of NA continuous therapy was found in nearly all subgroups.Conclusion:NA continuous therapy is associated with reduced risks of liver decompensation, hepatic failure, and overall mortality.