Maintained virologic response to entecavir or lamivudine associates with short- and long-term transplant-free survival of patients with hepatitis B virus (HBV)-related decompensated cirrhosis, researchers report in the December issue of Clinical Gastroenterology and Hepatology. The benefits are maintained for up to 10 years, but patients are still at risk for hepatocellular carcinoma (HCC).
Only 14% to 35% of patients with decompensated cirrhosis (characterized by ascites, variceal bleeding, encephalopathy, or other events) survive for 5 years, compared to 80% to 85% for patients with compensated cirrhosis. Active HBV replication with high levels of HBV DNA is associated with a worse outcome compared with a low or undetectable level of HBV DNA.
Oral nucleos(t)ide analogues rapidly inhibit HBV replication, reducing liver inflammation in patients with HBV-related decompensation. Entecavir is a potent antiviral drug with minimal drug resistance in treatment-naive patients and has good safety profiles, and superior efficacy compared with lamivudine. However, it is not clear if either drug associates with better outcomes of patients with decompensated cirrhosis. Little is known about their effects on the long-term incidence of HCC and liver function.