Use of nucleoside (Tide) analogues in patients with hepatitis B-related acute liver failure

Doan Y. Dao, Veeral Ajmera, William M. Lee, Emmanuel Seremba, Corron Sanders, Linda S. Hynan

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background and Aims The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF. Methods The US Acute Liver Failure Study Group, a 23-site registry, prospectively enrolled 1,413 patients with ALF with different etiologies between 1998 and 2008. Of those, 105 patients were identified as HBV-ALF patients, of whom we excluded those without data on NA use or with co-infection with hepatitis C, leaving 85 patients, 43 of whom had received NA treatment. HBV-DNA on admission was quantified by real time polymerase chain reaction. Results The treated and untreated groups were similar in most respects but differed significantly in regard to higher aminotransferase and bilirubin levels and hepatic coma grades, all being observed in the untreated group. Median duration of NA treatment was 6 days (range, 1-21 days). Overall survival in the NA treated and untreated groups were 61 and 64%, respectively (P = 0.72). Rates of transplant-free survival were 21 and 36% in the treated and untreated groups, respectively (P = 0.42). Multivariate analysis revealed that not using a NA [odds ratio (OR) 4.4, 95% CI 1.1-18.1, P = 0.041], hepatic coma grade I or II [OR 14.4, 95% CI 3.3-62.8, P < 0.001] and prothrombin time (PT) [OR 0.59, 95% CI 0.39-0.89, P = 0.012] were predictors of improved transplant-free survival. Conclusions Patients who are admitted with established HBV-ALF do not appear to benefit from viral suppression using nucleoside(tide) analogues presumably because of rapid disease evolution and short treatment duration. Despite the lack of benefit, NAs should still be given to transplantation candidates since viral suppression prevents recurrence after grafting.

Original languageEnglish (US)
Pages (from-to)1349-1357
Number of pages9
JournalDigestive Diseases and Sciences
Volume57
Issue number5
DOIs
StatePublished - May 2012

Fingerprint

Acute Liver Failure
Hepatitis B
Nucleosides
Hepatic Encephalopathy
Odds Ratio
Survival
Transplants
Prothrombin Time
Therapeutics
Hepatitis C
Transaminases
Coinfection
Bilirubin
Hepatitis B virus
Registries
Real-Time Polymerase Chain Reaction
Multivariate Analysis
Transplantation
Recurrence
DNA

Keywords

  • Liver transplantation
  • Severe viral hepatitis

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Use of nucleoside (Tide) analogues in patients with hepatitis B-related acute liver failure. / Dao, Doan Y.; Ajmera, Veeral; Lee, William M.; Seremba, Emmanuel; Sanders, Corron; Hynan, Linda S.

In: Digestive Diseases and Sciences, Vol. 57, No. 5, 05.2012, p. 1349-1357.

Research output: Contribution to journalArticle

Dao, Doan Y. ; Ajmera, Veeral ; Lee, William M. ; Seremba, Emmanuel ; Sanders, Corron ; Hynan, Linda S. / Use of nucleoside (Tide) analogues in patients with hepatitis B-related acute liver failure. In: Digestive Diseases and Sciences. 2012 ; Vol. 57, No. 5. pp. 1349-1357.
@article{c4d1bd37617647d7aa552f3dae305988,
title = "Use of nucleoside (Tide) analogues in patients with hepatitis B-related acute liver failure",
abstract = "Background and Aims The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF. Methods The US Acute Liver Failure Study Group, a 23-site registry, prospectively enrolled 1,413 patients with ALF with different etiologies between 1998 and 2008. Of those, 105 patients were identified as HBV-ALF patients, of whom we excluded those without data on NA use or with co-infection with hepatitis C, leaving 85 patients, 43 of whom had received NA treatment. HBV-DNA on admission was quantified by real time polymerase chain reaction. Results The treated and untreated groups were similar in most respects but differed significantly in regard to higher aminotransferase and bilirubin levels and hepatic coma grades, all being observed in the untreated group. Median duration of NA treatment was 6 days (range, 1-21 days). Overall survival in the NA treated and untreated groups were 61 and 64{\%}, respectively (P = 0.72). Rates of transplant-free survival were 21 and 36{\%} in the treated and untreated groups, respectively (P = 0.42). Multivariate analysis revealed that not using a NA [odds ratio (OR) 4.4, 95{\%} CI 1.1-18.1, P = 0.041], hepatic coma grade I or II [OR 14.4, 95{\%} CI 3.3-62.8, P < 0.001] and prothrombin time (PT) [OR 0.59, 95{\%} CI 0.39-0.89, P = 0.012] were predictors of improved transplant-free survival. Conclusions Patients who are admitted with established HBV-ALF do not appear to benefit from viral suppression using nucleoside(tide) analogues presumably because of rapid disease evolution and short treatment duration. Despite the lack of benefit, NAs should still be given to transplantation candidates since viral suppression prevents recurrence after grafting.",
keywords = "Liver transplantation, Severe viral hepatitis",
author = "Dao, {Doan Y.} and Veeral Ajmera and Lee, {William M.} and Emmanuel Seremba and Corron Sanders and Hynan, {Linda S.}",
year = "2012",
month = "5",
doi = "10.1007/s10620-011-2013-3",
language = "English (US)",
volume = "57",
pages = "1349--1357",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
publisher = "Springer New York",
number = "5",

}

TY - JOUR

T1 - Use of nucleoside (Tide) analogues in patients with hepatitis B-related acute liver failure

AU - Dao, Doan Y.

AU - Ajmera, Veeral

AU - Lee, William M.

AU - Seremba, Emmanuel

AU - Sanders, Corron

AU - Hynan, Linda S.

PY - 2012/5

Y1 - 2012/5

N2 - Background and Aims The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF. Methods The US Acute Liver Failure Study Group, a 23-site registry, prospectively enrolled 1,413 patients with ALF with different etiologies between 1998 and 2008. Of those, 105 patients were identified as HBV-ALF patients, of whom we excluded those without data on NA use or with co-infection with hepatitis C, leaving 85 patients, 43 of whom had received NA treatment. HBV-DNA on admission was quantified by real time polymerase chain reaction. Results The treated and untreated groups were similar in most respects but differed significantly in regard to higher aminotransferase and bilirubin levels and hepatic coma grades, all being observed in the untreated group. Median duration of NA treatment was 6 days (range, 1-21 days). Overall survival in the NA treated and untreated groups were 61 and 64%, respectively (P = 0.72). Rates of transplant-free survival were 21 and 36% in the treated and untreated groups, respectively (P = 0.42). Multivariate analysis revealed that not using a NA [odds ratio (OR) 4.4, 95% CI 1.1-18.1, P = 0.041], hepatic coma grade I or II [OR 14.4, 95% CI 3.3-62.8, P < 0.001] and prothrombin time (PT) [OR 0.59, 95% CI 0.39-0.89, P = 0.012] were predictors of improved transplant-free survival. Conclusions Patients who are admitted with established HBV-ALF do not appear to benefit from viral suppression using nucleoside(tide) analogues presumably because of rapid disease evolution and short treatment duration. Despite the lack of benefit, NAs should still be given to transplantation candidates since viral suppression prevents recurrence after grafting.

AB - Background and Aims The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF. Methods The US Acute Liver Failure Study Group, a 23-site registry, prospectively enrolled 1,413 patients with ALF with different etiologies between 1998 and 2008. Of those, 105 patients were identified as HBV-ALF patients, of whom we excluded those without data on NA use or with co-infection with hepatitis C, leaving 85 patients, 43 of whom had received NA treatment. HBV-DNA on admission was quantified by real time polymerase chain reaction. Results The treated and untreated groups were similar in most respects but differed significantly in regard to higher aminotransferase and bilirubin levels and hepatic coma grades, all being observed in the untreated group. Median duration of NA treatment was 6 days (range, 1-21 days). Overall survival in the NA treated and untreated groups were 61 and 64%, respectively (P = 0.72). Rates of transplant-free survival were 21 and 36% in the treated and untreated groups, respectively (P = 0.42). Multivariate analysis revealed that not using a NA [odds ratio (OR) 4.4, 95% CI 1.1-18.1, P = 0.041], hepatic coma grade I or II [OR 14.4, 95% CI 3.3-62.8, P < 0.001] and prothrombin time (PT) [OR 0.59, 95% CI 0.39-0.89, P = 0.012] were predictors of improved transplant-free survival. Conclusions Patients who are admitted with established HBV-ALF do not appear to benefit from viral suppression using nucleoside(tide) analogues presumably because of rapid disease evolution and short treatment duration. Despite the lack of benefit, NAs should still be given to transplantation candidates since viral suppression prevents recurrence after grafting.

KW - Liver transplantation

KW - Severe viral hepatitis

UR - http://www.scopus.com/inward/record.url?scp=84863615647&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863615647&partnerID=8YFLogxK

U2 - 10.1007/s10620-011-2013-3

DO - 10.1007/s10620-011-2013-3

M3 - Article

C2 - 22198704

AN - SCOPUS:84863615647

VL - 57

SP - 1349

EP - 1357

JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

SN - 0163-2116

IS - 5

ER -