What to start with in first line treatment of chronic hepatitis B patients: An Italian multicentre observational cohort, HBV-RER study group

Gianluca Cuomo, Vanni Borghi, Tiziana Giuberti, Pietro Andreone, Marco Massari, Erica Villa, Antonello Pietrangelo, Gabriella Verucchi, Fabio Levantesi, Carlo Ferrari

Research output: Contribution to journalArticlepeer-review

Abstract

Treatment options for chronic hepatitis B (CHB) are pegylated interferon (Peg-IFN) in minimal/mild liver fibrosis and nucleot(s)ide analogues (NUC) in more advanced disease. Since little is known about their use in daily clinical practice, we conducted a multicentre prospective study to investigate treatment regimens applied to naïve CHB patients in real life. HBV-RER is an observational multicentre Italian network that collect clinic and virologic data of patients with CHB. Among the 2527 CHB patients seen during the study period (2009-2012), 502 patients started a first line antiviral treatment. Liver biopsy was performed in 30.9% of the patients, with high levels of fibrosis being detected in 19.4% of them. In 216 patients (43%) Peg-IFN was used as first-line therapy while the remaining patients started NUC therapy (entecavir and tenofovir in 75%, lamivudine in 15%, telbivudine and adefovir 10%). By multivariate logistic regression, an age under 40 (OR 0.92, 95%IC 0.90-0.94; p<0.001) and the execution of liver biopsy (OR 3.83; 95%IQR 1.76-8.36; p<0.001) were the only determinants of choice between Peg-IFN vs NUC. Peg-IFN was expected to be used in first-line treatment for CHB in 70% of the patients based on Italian recommendations, but a much lower proportion of patients were actually treated with Peg-IFN with a limited use of the biopsy. Thus, in daily clinical practice physicians prefer to use NUCs, presumably because of their optimal tolerability and anti-viral efficacy, even if they frequently require life-long treatment as opposed to the short duration of Peg-IFN.

Original languageEnglish
Pages (from-to)150-157
Number of pages8
JournalInfezioni in Medicina
Volume25
Issue number2
Publication statusPublished - 2017

Keywords

  • Chronic hepatitis B
  • HBV
  • Pegylated interferon

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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