Antiviral treatment and liver-related complications in hepatitis delta
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Antiviral treatment and liver-related complications in hepatitis delta. / Wranke, Anika; Serrano, Beatriz Calle; Heidrich, Benjamin; Kirschner, Janina; Bremer, Birgit; Lehmann, Patrick; Hardtke, Svenja; Deterding, Katja; Port, Kerstin; Westphal, Max; Manns, Michael P; Cornberg, Markus; Wedemeyer, Heiner.
in: HEPATOLOGY, Jahrgang 65, Nr. 2, 02.2017, S. 414-425.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Antiviral treatment and liver-related complications in hepatitis delta
AU - Wranke, Anika
AU - Serrano, Beatriz Calle
AU - Heidrich, Benjamin
AU - Kirschner, Janina
AU - Bremer, Birgit
AU - Lehmann, Patrick
AU - Hardtke, Svenja
AU - Deterding, Katja
AU - Port, Kerstin
AU - Westphal, Max
AU - Manns, Michael P
AU - Cornberg, Markus
AU - Wedemeyer, Heiner
N1 - © 2016 by the American Association for the Study of Liver Diseases.
PY - 2017/2
Y1 - 2017/2
N2 - Hepatitis delta virus (HDV) is the most severe form of viral hepatitis. Pegylated interferon alfa (PEG-IFNα) is effective in only 25%-30% of patients and is associated with frequent side effects. The aim of this study was to analyze the clinical long-term outcome of hepatitis delta in relation to different antiviral treatment strategies. We studied 136 anti-HDV-positive patients who were followed for at least 6 months in a retrospective single-center cohort (mean time of follow-up, 5.2 years; range, 0.6-18.8). Liver cirrhosis was already present in 62 patients at first presentation. Twenty-nine percent of patients did not receive any antiviral treatment, 38% were treated with interferon alfa (IFNα)-based therapies, and 33% received nucleos(t)ide analogues (NAs) only. Clinical endpoints defined as hepatic decompensation (ascites, encephalopathy, and variceal bleeding), hepatocellular carcinoma, liver transplantation, and liver-related death developed in 55 patients (40%). Patients who received IFNα-based therapies developed clinical endpoints less frequently than those treated with NA (P = 0.02; HR, 4.0) or untreated patients (P = 0.05; HR, 2.2; 17%, 64%, and 44%), respectively, which was significant in both chi-square and Kaplan-Meier analysis. In addition, considering various clinical and virological parameters, IFNα therapy was independently associated with a more benign clinical long-term outcome in multivariate logistic regression analysis (P = 0.04; odds ratio, 0.25; 95% confidence interval, 0.07-0.9). Loss of HDV RNA during follow-up was more frequent in IFNα-treated patients and strongly linked with a lower likelihood to experience liver-related complications.CONCLUSION: IFNα-based antiviral therapy of hepatitis delta was independently associated with a lower likelihood for clinical disease progression. Durable undetectability of HDV RNA is a valid surrogate endpoint in the treatment of hepatitis delta. (Hepatology 2017;65:414-425).
AB - Hepatitis delta virus (HDV) is the most severe form of viral hepatitis. Pegylated interferon alfa (PEG-IFNα) is effective in only 25%-30% of patients and is associated with frequent side effects. The aim of this study was to analyze the clinical long-term outcome of hepatitis delta in relation to different antiviral treatment strategies. We studied 136 anti-HDV-positive patients who were followed for at least 6 months in a retrospective single-center cohort (mean time of follow-up, 5.2 years; range, 0.6-18.8). Liver cirrhosis was already present in 62 patients at first presentation. Twenty-nine percent of patients did not receive any antiviral treatment, 38% were treated with interferon alfa (IFNα)-based therapies, and 33% received nucleos(t)ide analogues (NAs) only. Clinical endpoints defined as hepatic decompensation (ascites, encephalopathy, and variceal bleeding), hepatocellular carcinoma, liver transplantation, and liver-related death developed in 55 patients (40%). Patients who received IFNα-based therapies developed clinical endpoints less frequently than those treated with NA (P = 0.02; HR, 4.0) or untreated patients (P = 0.05; HR, 2.2; 17%, 64%, and 44%), respectively, which was significant in both chi-square and Kaplan-Meier analysis. In addition, considering various clinical and virological parameters, IFNα therapy was independently associated with a more benign clinical long-term outcome in multivariate logistic regression analysis (P = 0.04; odds ratio, 0.25; 95% confidence interval, 0.07-0.9). Loss of HDV RNA during follow-up was more frequent in IFNα-treated patients and strongly linked with a lower likelihood to experience liver-related complications.CONCLUSION: IFNα-based antiviral therapy of hepatitis delta was independently associated with a lower likelihood for clinical disease progression. Durable undetectability of HDV RNA is a valid surrogate endpoint in the treatment of hepatitis delta. (Hepatology 2017;65:414-425).
KW - Adolescent
KW - Adult
KW - Analysis of Variance
KW - Antiviral Agents/adverse effects
KW - Cause of Death
KW - Chi-Square Distribution
KW - Cohort Studies
KW - Disease Progression
KW - Dose-Response Relationship, Drug
KW - Drug Administration Schedule
KW - Drug Therapy, Combination
KW - Female
KW - Follow-Up Studies
KW - Germany
KW - Hepatitis D/diagnosis
KW - Hepatitis Delta Virus/drug effects
KW - Humans
KW - Interferon-alpha/adverse effects
KW - Kaplan-Meier Estimate
KW - Liver/drug effects
KW - Liver Cirrhosis/etiology
KW - Liver Neoplasms/etiology
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Reference Values
KW - Retrospective Studies
KW - Risk Assessment
KW - Severity of Illness Index
KW - Survival Analysis
KW - Time Factors
KW - Treatment Outcome
KW - Young Adult
U2 - 10.1002/hep.28876
DO - 10.1002/hep.28876
M3 - SCORING: Journal article
C2 - 27770553
VL - 65
SP - 414
EP - 425
JO - HEPATOLOGY
JF - HEPATOLOGY
SN - 0270-9139
IS - 2
ER -
