Back Hepatitis B Hepatitis B Topics HBV Treatment

Chinese Herbs Taken with Lamivudine May Reduce Hepatitis B Mortality

Hepatitis B patients who used traditional Chinese medicine, including the herbal preparation Jia-Wei-Xiao-Yao-San, while being treated with lamivudine (3TC or Epivir) were less likely to die of any cause than non-users, according to research published in the November 4, 2015, Journal of Enthopharmacology.

alt

Read more:

Tenofovir Alafenamide Is Effective Against Hepatitis B with Less Kidney and Bone Toxicity

A pair of Phase 3 studies have shown that Gilead Sciences' new tenofovir alafenamide (TAF) suppresses hepatitis B virus (HBV) as well as the current tenofovir disoproxil fumarate (TDF) formulation, but with less detrimental effects on the kidneys and bones, the company announced this week.

alt

Read more:

AASLD 2015: REP 2139 Shows Promise for People with Hepatitis B and Hepatitis Delta Coinfection

The nucleic acid-based polymer REP 2139, used first as monotherapy then combined with pegylated interferon, reduced hepatitis B surface antigen (HBsAg) levels, lowered hepatitis delta viral load, and increased anti-HBs antibody titers, according to findings from a small Phase 2 study presented at the AASLD Liver Meeting taking place this week in San Francisco. Participants fell into 2 distinct groups, with half being partial responders and half full responders.

alt

Read more:

Coverage of the 2015 AASLD Liver Meeting

HIVandHepatitis.com coverage of the 2015 American Association for the Study of Liver Diseases (AASLD) Liver Meeting in San Francisco, November 13-17, 2015.

Conference highlights include interferon-free therapy for hepatitis C, treatment for difficult-to-treat populations including people with HCV genotype 3 and liver  cirrhosis, hepatitis B prevention and treatment, and management of advanced liver disease.

Full listing by topic

Liver Meeting website

11/23/15

alt

Bone and Kidney Problems Uncommon Among Hepatitis B Patients on Long-term Antiviral Therapy

Long-term hepatitis B treatment using nucleoside/nucleotide antivirals appears safe over a follow-up period of 5 years, according to a large study from Hong Kong published in the September edition of Hepatology. Researchers saw no significant rise in the likelihood of kidney-related adverse events, and while nucleotide analogs were associated with an increased occurrence of hip fractures, the risk remained very low.

alt

Antiviral therapy using nucleoside/nucleotide analogs such as lamivudine (Epivir), entecavir (Baraclude), adefovir (Hepsera), or tenofovir (Viread) is the mainstay of chronic hepatitis B treatment. While these antiviral drugs can effectively suppress hepatitis B virus (HBV) replication during treatment, they usually do not lead to a cure -- as indicated by HBsAg loss and HBs antibody seroconversion -- necessitating long-term therapy.

The nucleoside/nucleotide analogs commonly used for hepatitis B treatment are considered generally safe and well-tolerated. However, the nucleotides adefovir and tenofovir are associated with kidney toxicity (in fact, adefovir was never approved for HIV treatment for this reason). Used as a treatment for HIV, tenofovir can cause or worsen kidney impairment in susceptible individuals and often causes a small amount of bone loss after starting therapy. Long-term side effects have not been as extensively studied in people using it for hepatitis B.

Grace Lai-Hung Wong from the Chinese University of Hong Kong evaluated the risk of kidney and bone side effects in patients who received nucleoside/nucleotide analogs as hepatitis B treatment.

This cohort study used data from Hospital Authority, the major provider of medical services in Hong Kong, looking at more than 53,000 patients diagnosed with HBV infection between 2000 and 2012.

The primary events of interest were incident (new) kidney failure, renal replacement therapy or kidney dialysis, and incident fractures of the hip, vertebra, and all sites.

Among the 53,500 total hepatitis B patients, 7046 had been treated with nucleoside/nucleotide analogswhile 46,454 remained untreated. Those who were event-free for 3 years were included in the analysis.

Results

  • After a median follow-up period of 4.9 years, adverse events occurred with the following frequencies in treated and untreated patients:

           o   Chronic kidney failure: 1.4% vs 0.6%;

           o   Renal replacement therapy: 0.7% vs 0.2%;

           o   All fractures: 1.3% vs 0.7%;

           o   Hip fractures: 0.2% vs 0.1%;

           o   Vertebra fractures: 0.2% vs 0.1%.

  • While adverse events occurred more often among treated people, nucleoside/nucleotide analog therapy was not associated with a significant increase in the risk of any of these events after propensity score weighting (hazard ratio [HR] 0.79 to 1.31; p= 0.225-0.887).
  • Looking only at nucleotide analogs (not nucleoside analogs), exposure was associated with a significantly increased risk of hip fractures (HR 5.69; 95% confidence interval 1.98-16.39; p=0.001), but not other events (HR 0.58-1.44; p=0.202-0.823).

"[Nucleoside/nucleotide analog]treatment does not increase the risk of renal and bone events in general," the study authors concluded. "Nucleotide analogs may increase the risk of hip fracture, but the overall event rate is low."

These findings provide reassuring evidence that the likelihood of serious kidney and bone side effects while using long-term antiviral therapy for hepatitis B is low. However, they suggest that ongoing kidney function and bone density monitoring is advisable during adefovir or tenofovir treatment, and that people with pre-existing kidney or bone problems should be treated cautiously or avoid these drugs.

10/1/15

Reference

GLH Wong, YK Tse, VWS Wong, et al. Long-term safety of oral nucleos(t)ide analogs for patients with chronic hepatitis B: A cohort study of 53,500 subjects. Hepatology 62(3):684-693. September 2015.