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HBV therapy nonadherence increases risk for liver-related complications

Medication nonadherence among patients with hepatitis B increased the risk for hepatocellular carcinoma, cirrhotic complications and all-cause mortality, according to recently published data.

“Adherence appears to be a key factor in minimizing [liver-related events (LRE)],” Neung Hwa Park, MD, PhD, from the University of Ulsan College of Medicine in the Republic of Korea, and colleagues wrote. “Considering that poor adherence increased the risk of LREs in this study, identifying an effective medical strategy to improve adherence to medication may substantially improve clinical outcomes.”

The observational study comprised 894 treatment-naive patients with chronic HBV who received treatment with Baraclude (entecavir, Bristol-Myers Squibb) between January 2007 and January 2017. Median follow-up during therapy was 5.4 years (range, 3-7.3 years).

The mean adherence rate was 89.1%. Only 296 patients had complete adherence. Among the 617 patients whose adherence rates were 90% or lower, 94 patients had adherence rates lower than 70% and 183 patients ranged between 70% and less than 90%.

Multivariate analysis showed that age younger than 30 years or older than 70 years correlated significantly with good medication adherence (HR = 1.8; 95% CI, 1.09-2.964).

Patients with adherence of 90% or higher had significantly higher rates of virologic response (92.1% vs. 78.3%; P < .001) and maintained virologic response (82% vs. 50.2%; P < .001), and lower rates of virologic breakthrough (1.8% vs. 24.9%; P < .001) compared with those with lower adherence rates.

In contrast, patients with adherence rates lower than 90% increased their risk for HCC by 2.9-fold (95% CI, 1.761-4.643), cirrhotic complications by 2.9-fold (95% CI, 1.925-4.247), liver-related mortality by 14.3-fold (95% CI, 3.493-58.468) and all-cause mortality by fivefold (95% CI, 2.185-11.265).

“Sustained HBV viral suppression produces clinical benefits through preventing disease progression, reducing hepatic decompensation and by preventing HCC development in patients with [chronic HBV],” the researchers wrote. “Antiviral resistance was the primary reason for treatment failure in the good adherence group, and poor adherence to medication was the primary reason for treatment failure in the poor adherence group.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.