Evaluation of Current Treatment Recommendations for Chronic Hepatitis B: A 2011 Update

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06623.x/abstract

Evaluation of Current Treatment Recommendations for Chronic Hepatitis B: A 2011

Update

Myron Tong Ph.D., M.D.1,2,*, Leeyen Hsu B.S.2, W. Chang2, Lawrence

Blatt Ph.D.2DOI: 10.1111/j.1440-1746.2011.06623.x

¿ 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background/Aims: Guidelines for the treatment of chronic hepatitis B have been

recently updated in the 2009 EASL consensus statement, the 2008 United States

Panel, the 2008 Asian-Pacific consensus statement, and the 2009 AASLD practice

guidelines. We sought to determine whether these guidelines identified patients

who developed hepatocellular carcinoma (HCC) or who died of non-HCC

liver-related deaths for anti-viral therapy.

Methods: The criteria described in the new treatment guidelines were matched to

the database of 369 HBsAg-positive patients in whom 30 developed HCC and 37 died

of non-HCC liver-related deaths during a mean follow-up of 84 months.

Results: Using criteria for anti-viral therapy as stated by the four current

guidelines, 19-30% of patients who died of non-HCC liver-related complications

and 23-53% of patients who developed HCC would have been excluded for anti-viral

therapy. If baseline serum albumin levels of ˜3.5g/dl or platelet counts of

˜130,000mm3 were included into the treatment criteria, then 85% to 94% of

patients who developed liver-related complications would have been recommended

for anti-viral therapy. Also, the addition of precore A1896 mutants and basal

core promoter T1762/A1764 mutants would have identified 98.5% to 100% of these

patients.

Conclusion: The updated treatment guidelines for hepatitis B still excluded

patients who developed serious liver-related complications. The inclusion of

baseline serum albumin and platelet counts to current criteria would have

identified a majority of these patients for anti-viral therapy. These tests

should be included into hepatitis B treatment strategies.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06623.x/abstract

Evaluation of Current Treatment Recommendations for Chronic Hepatitis B: A 2011

Update

Myron Tong Ph.D., M.D.1,2,*, Leeyen Hsu B.S.2, W. Chang2, Lawrence

Blatt Ph.D.2DOI: 10.1111/j.1440-1746.2011.06623.x

¿ 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background/Aims: Guidelines for the treatment of chronic hepatitis B have been

recently updated in the 2009 EASL consensus statement, the 2008 United States

Panel, the 2008 Asian-Pacific consensus statement, and the 2009 AASLD practice

guidelines. We sought to determine whether these guidelines identified patients

who developed hepatocellular carcinoma (HCC) or who died of non-HCC

liver-related deaths for anti-viral therapy.

Methods: The criteria described in the new treatment guidelines were matched to

the database of 369 HBsAg-positive patients in whom 30 developed HCC and 37 died

of non-HCC liver-related deaths during a mean follow-up of 84 months.

Results: Using criteria for anti-viral therapy as stated by the four current

guidelines, 19-30% of patients who died of non-HCC liver-related complications

and 23-53% of patients who developed HCC would have been excluded for anti-viral

therapy. If baseline serum albumin levels of ˜3.5g/dl or platelet counts of

˜130,000mm3 were included into the treatment criteria, then 85% to 94% of

patients who developed liver-related complications would have been recommended

for anti-viral therapy. Also, the addition of precore A1896 mutants and basal

core promoter T1762/A1764 mutants would have identified 98.5% to 100% of these

patients.

Conclusion: The updated treatment guidelines for hepatitis B still excluded

patients who developed serious liver-related complications. The inclusion of

baseline serum albumin and platelet counts to current criteria would have

identified a majority of these patients for anti-viral therapy. These tests

should be included into hepatitis B treatment strategies.