1Division of Gastroenterology & Hepatology, Oregon Health & Science University, Portland, OR, USA.
2Gastroenterology/Hepatology Division, Tufts Medical Center, Boston, MA, USA.
3Digestive Diseases, Yale University, New Haven, CT, USA.
4Department of Medicine, NYU Langone, New York, NY, USA.
5Division of Gastroenterology & Hepatology, Stanford University, Stanford, CA, USA.
6San Jose Gastroenterology, San Jose, CA, USA.
7Albert Einstein College of Medicine, New York, NY, USA.
8Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
9Division of Gastroenterology, Mount Sinai Beth Israel, New York, NY, USA.
10Digestive Health Associates of Texas, Plano, TX, USA.
11Digestive Disease Center, University of Chicago, Chicago, IL, USA.
12Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA.
13Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
Entecavir (ETV) has been shown to be safe and efficacious in randomised controlled trials in highly selected patients with hepatitis B virus (HBV) infection.
To determine the safety and effectiveness of ETV in 'real-world' HBV patients in the United States (US).
Treatment-naïve HBV patients ≥18 years old who received ETV for ≥12 months between 2005 and 2013 were included in a retrospective, cohort study. Rates of ALT normalisation, undetectable HBV DNA, HBeAg and HBsAg loss/seroconversion, adverse events (AE) and clinical outcomes were evaluated.
Of 841 patients, 658 [65% male, 83% Asian; median age 47 years] met the inclusion criteria. 36% were HBeAg+ and 9.3% cirrhotic. 89% had abnormal ALT. Baseline median HBV DNA was 5.8 log 10 IU/mL. Median duration of ETV treatment was 4 years. Rates of ALT normalisation at 1, 3 and 5 years were 37.2%, 48.7% and 56.2% in HBeAg+ and 39.6%, 46.8% and 55.6% in HBeAg- patients. HBV DNA was undetectable at 1, 3 and 5 years in 34.6%, 64.7% and 84.6% in HBeAg+ patients, and 81.9%, 90.3% and 96.2% in HBeAg patients. Five-year cumulative probability of HBeAg loss and seroconversion was 46% and 33.7% and HBsAg loss was 4.6%. ETV was discontinued due to adverse events in 1.2% of patients. Hepatic decompensation occurred in 0.8%, liver cancer in 2.7% and death in 0.6%.
Entecavir treatment was safe in a large cohort of US patients, but ALT normalisation and hepatitis B virus DNA suppression rates were lower than previously reported in clinical trials.