Journal of the Chinese Medical Association : JCMA 2017 09 3080(12) 758-765 pii 10.1016/j.jcma.2017.07.009
Lack of nucleos(t)ide analogue (NA) prophylaxis prior to chemotherapy is a common problem worldwide. The efficacy of newer-generation NAs in the rescue for the hepatitis B virus (HBV) reactivation has not been confirmed. We aimed to compare lamivudine (LVD) and entecavir (ETV) in the rescue of chemotherapy-induced HBV flare-up.
In this retrospective cohort study, we screened all HBV carriers who received therapeutic LVD or ETV for hepatitis flare-up after chemotherapy between January 1, 2004 and December 31, 2015. Patients who had other concurrent primary liver diseases such as chronic hepatitis C, who had baseline HBV viral load <2000 IU/ml or data unavailable, or those who had primary or secondary liver cancers were excluded. By means of propensity scores, LVD users were randomly matched 1:1 with ETV users. Cumulative incidences of, and hazard ratios (HRs) for, mortality at 6 months were analyzed, and 1-year virological responses were evaluated. RESULTS
In total, 32 LVD and 32 ETV users were matched for outcome analysis, and their baseline characteristics were not significantly different. Comparing LVD users to ETV users, the 6-month liver-related mortality rates (6.3% vs. 12.5%, p = 0.47) and overall mortality rates (31.3% vs. 25%, p = 0.54) were not significantly different. In multivariate analysis, prothrombin time prolongation >4 s (HR: 10.78, 95% confidence interval [CI]: 1.55-74.93) and HBV viral load L (HR: 3.40 per 1 log IU/ml, 95% CI: 1.39-8.40) were independent prognostic factors for liver-related mortality. There was no drug resistance to LVD or ETV over the course of 1 year.
Clinical outcomes were not different between LVD and ETV users. Delayed detection of hepatitis flare-up with coagulopathy and a high viral load could result in a poor prognosis.