Monitoring and comorbidities in patients with chronic hepatitis B currently treated with nucleos(t)ide analogs

Spyros Siakavellas; John Goulis; Spilios Manolakopoulos; Christos Triantos; Nikolaos Gatselis; Eva Tsentemidou; Hariklia Kranidioti; Κonstantinos Ζisimopoulos; Christos Τsoulas; George Dalekos; George Papatheodoridis

Authors Spyros Siakavellas, John Goulis, Spilios Manolakopoulos, Christos Triantos, Nikolaos Gatselis, Eva Tsentemidou, Hariklia Kranidioti, Κonstantinos Ζisimopoulos, Christos Τsoulas, George Dalekos, George Papatheodoridis.

Abstract

Background Long-term monotherapy with nucleos(t)ide analogs (NAs) represents the treatment option for the majority of patients with chronic hepatitis B (CHB), an aging population with a greater likelihood of comorbidities. We assessed the prevalence of concurrent non-hepatic diseases and the safety monitoring in a large cohort of CHB patients receiving NAs and their potential impact on disease outcomes.

Methods We included 500 consecutive CHB patients from 5 major tertiary Greek centers, under long-term therapy with an NA. Epidemiological/clinical characteristics and data on concomitant disease, drug use and investigations ordered were collected.

Results The mean age was 58 years and 66% were male. Most patients were receiving tenofovir disoproxil fumarate (TDF, 60%) or entecavir (ETV, 37%) monotherapy. Decompensated cirrhosis at baseline was present in 10%, while hepatocellular carcinoma (HCC) under therapy developed in 21 patients. The median duration of total NA therapy was 56 and of latest therapy 42 months. The most common (prevalence >10%) comorbidities were hypertension (28%), non-HCC cancer(s) (12%), and diabetes (11%). Patients with a longer duration of latest therapy (≥4 vs. <4 years) were older (mean age: 58 vs. 56 years, P=0.004), had more frequent history of prior use of NA(s) (53% vs. 35%, P<0.001), and less frequent liver decompensation (5% vs. 13%, P=0.008) and non-HCC cancers (8% vs. 15%, P=0.020). HCC developed more frequently in patients with than in those without diabetes (11% vs. 3%, P=0.022).

Conclusion Greek CHB patients currently treated with NAs, almost exclusively ETV or TDF, are often older than 60 years, have several comorbidities, and thus require careful management.

Keywords Chronic hepatitis B, nucleos(t)ide analog, comorbidities, monitoring

Ann Gastroenterol 2021; 34 (1): 73-79