Effective antiviral therapy significantly reduces liver fibrosis in patients with chronic hepatitis B (CHB) and reduces the incidence of hepatic decompensation and the risk of hepatocellular carcinoma (HCC) in patients with CHB. However, few studies have directly investigated the relationship between regression of liver fibrosis and liver-related events (LREs) in patients with CHB, including liver decompensation, HCC, liver transplantation, or death. A recent study investigated the relationship between liver fibrosis regression scores and liver-related events (LREs) in patients with chronic hepatitis B.
1. Research Methodology
Patients with CHB with significant fibrosis/cirrhosis were included and assessed for regression of fibrosis based on the P-I-R score of the Beijing grade. LREs are defined as decompensation, hepatocellular carcinoma, liver transplantation, or death. The Cox proportional hazards model was used to determine the relationship between fibrosis regression and LREs.
2. Findings
1. Cumulative incidence of liver-related events
The cumulative incidence of 7-year LREs was 9.4%, including 4.4% for decompensation and 5.9% for HCC. During the follow-up assessment, the overall incidence of decompensation and HCC was similar (Figure 1A).
Fig. 1 Cumulative incidence of LREs, decompensation, and HCC
2. Correlation between resolution of fibrosis and low risk of liver-related events
Patients with regression of fibrosis had a significantly reduced risk of LREs compared with patients with progressive liver fibrosis (HR, 0.19; 95% CI, 0.09–0.39; P<.001); Regression of fibrosis reduced the risk of LREs by 5.8 times (P<.001).
Patients with regressive fibrosis had a significantly lower risk of LREs compared with patients with uncertain liver fibrosis (HR, 0.43; 95% CI, 0.24–0.79; P<.006); Regression of fibrosis reduced the risk of LREs by 2.4 times (P<.001).
A reduced risk of LREs was also observed in patients with regression of fibrosis after adjusting for age and sex (adjusted HR, 0.22; 95% CI, 0.10–0.46; P < .001).
Patients without LREs had a significantly higher rate of regression of liver fibrosis compared with those with LREs (15.8% vs. 45.1%) (Figure 1).
3. Conclusions of the study
Resolution of fibrosis in patients with chronic hepatitis B receiving antiviral therapy significantly reduces the risk of developing LREs, and resolution of liver fibrosis can be used as a surrogate endpoint for clinical events in patients with hepatitis B virus-associated fibrosis or early cirrhosis.
Bibliography:
Sun Y, Chen W, Chen S, Wu X, Zhang X, Zhang L, Zhao H, Xu M, Chen Y, Piao H, Li P, Li L, Jiang W, Li X, Xing H, Liu X, Zhang Y, Wang B, Zhou J, Meng T, Zhao X, Shao C, Kong Y, Zhao X, Ou X, Liu C, Jia J, You H. Regression of Liver Fibrosis in Patients on Hepatitis B Therapy Is Associated With Decreased Liver-Related Events. Clin Gastroenterol Hepatol. 2024 Mar; 22(3):591-601.e3.
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