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Association of nucleos(t)ide analogue therapy with reduced risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide cohort study.
Gastroenterology 2014; 147(1):143-151.e5G

Abstract

BACKGROUND & AIMS

Treatment for hepatitis B virus infection reduces the risk of hepatocellular carcinoma (HCC). However, the long-term protective effects for subgroups of patients with chronic hepatitis B are unclear.

METHODS

We conducted a retrospective nationwide cohort study using data from Taiwan's National Health Insurance Research Database (from January 1, 1997, through December 31, 2010). Cumulative incidences were calculated and multivariable analyses were carried out after adjusting for competing mortality. Propensity scores were used to match 21,595 patients with chronic hepatitis B who received nucleoside analogue therapy for at least 90 days (treated cohort) with 21,595 untreated patients with chronic hepatitis B (controls), who received hepatoprotectants for at least 90 days. Data were collected from the treated cohort for a mean period of 3.46 years and from controls for 5.24 years.

RESULTS

The treated cohort had a significantly lower 7-year incidence of HCC (7.32%; 95% confidence interval [CI], 6.77%-7.87%) than controls (22.7%; 95% CI, 22.1%-23.3%; P < .001). After adjusting for competing mortality and other confounders, nucleos(t)ide analogue treatment was associated with a reduced risk of HCC, with an adjusted hazard ratio of 0.37 (95% CI, 0.34-0.39; P < .001). Sensitivity analyses confirmed the association between nucleos(t)ide analogue treatment and reduced risk of HCC. Age, sex, cirrhosis, and diabetes mellitus modified this association.

CONCLUSIONS

Based on a retrospective, nationwide study in Taiwan, nucleoside analogue therapy use is associated with reduced risk of HCC in patients with chronic hepatitis B virus infection.

Authors+Show Affiliations

Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Public Health and Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan; Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan.School of Medicine, Fu Jen Catholic University, Taipei, Taiwan; Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan. Electronic address: jawtown@gmail.com.School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine and Genomic Research Center, National Yang-Ming University, Taipei, Taiwan; Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan.Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Public Health and Graduate Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.Institute of Clinical Medicine and Genomic Research Center, National Yang-Ming University, Taipei, Taiwan.Institute of Clinical Medicine and Genomic Research Center, National Yang-Ming University, Taipei, Taiwan.Institute of Clinical Medicine and Genomic Research Center, National Yang-Ming University, Taipei, Taiwan; Translational Research Division, Medical Research Department, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: jcwu@vghtpe.gov.tw.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24704525

Citation

Wu, Chun-Ying, et al. "Association of Nucleos(t)ide Analogue Therapy With Reduced Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B: a Nationwide Cohort Study." Gastroenterology, vol. 147, no. 1, 2014, pp. 143-151.e5.
Wu CY, Lin JT, Ho HJ, et al. Association of nucleos(t)ide analogue therapy with reduced risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide cohort study. Gastroenterology. 2014;147(1):143-151.e5.
Wu, C. Y., Lin, J. T., Ho, H. J., Su, C. W., Lee, T. Y., Wang, S. Y., ... Wu, J. C. (2014). Association of nucleos(t)ide analogue therapy with reduced risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide cohort study. Gastroenterology, 147(1), pp. 143-151.e5. doi:10.1053/j.gastro.2014.03.048.
Wu CY, et al. Association of Nucleos(t)ide Analogue Therapy With Reduced Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B: a Nationwide Cohort Study. Gastroenterology. 2014;147(1):143-151.e5. PubMed PMID: 24704525.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of nucleos(t)ide analogue therapy with reduced risk of hepatocellular carcinoma in patients with chronic hepatitis B: a nationwide cohort study. AU - Wu,Chun-Ying, AU - Lin,Jaw-Town, AU - Ho,Hsiu J, AU - Su,Chien-Wei, AU - Lee,Teng-Yu, AU - Wang,Shen-Yung, AU - Wu,Chuhui, AU - Wu,Jaw-Ching, Y1 - 2014/04/01/ PY - 2013/09/03/received PY - 2014/03/20/revised PY - 2014/03/26/accepted PY - 2014/4/8/entrez PY - 2014/4/8/pubmed PY - 2014/10/1/medline KW - Antiviral Agent KW - HBV KW - Hepatoma KW - NHIRD SP - 143 EP - 151.e5 JF - Gastroenterology JO - Gastroenterology VL - 147 IS - 1 N2 - BACKGROUND & AIMS: Treatment for hepatitis B virus infection reduces the risk of hepatocellular carcinoma (HCC). However, the long-term protective effects for subgroups of patients with chronic hepatitis B are unclear. METHODS: We conducted a retrospective nationwide cohort study using data from Taiwan's National Health Insurance Research Database (from January 1, 1997, through December 31, 2010). Cumulative incidences were calculated and multivariable analyses were carried out after adjusting for competing mortality. Propensity scores were used to match 21,595 patients with chronic hepatitis B who received nucleoside analogue therapy for at least 90 days (treated cohort) with 21,595 untreated patients with chronic hepatitis B (controls), who received hepatoprotectants for at least 90 days. Data were collected from the treated cohort for a mean period of 3.46 years and from controls for 5.24 years. RESULTS: The treated cohort had a significantly lower 7-year incidence of HCC (7.32%; 95% confidence interval [CI], 6.77%-7.87%) than controls (22.7%; 95% CI, 22.1%-23.3%; P < .001). After adjusting for competing mortality and other confounders, nucleos(t)ide analogue treatment was associated with a reduced risk of HCC, with an adjusted hazard ratio of 0.37 (95% CI, 0.34-0.39; P < .001). Sensitivity analyses confirmed the association between nucleos(t)ide analogue treatment and reduced risk of HCC. Age, sex, cirrhosis, and diabetes mellitus modified this association. CONCLUSIONS: Based on a retrospective, nationwide study in Taiwan, nucleoside analogue therapy use is associated with reduced risk of HCC in patients with chronic hepatitis B virus infection. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/24704525/Association_of_nucleos_t_ide_analogue_therapy_with_reduced_risk_of_hepatocellular_carcinoma_in_patients_with_chronic_hepatitis_B:_a_nationwide_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(14)00445-4 DB - PRIME DP - Unbound Medicine ER -