A Comparison Between Community and Academic Practices in the USA in the Management of Chronic Hepatitis B Patients Receiving Entecavir: Results of the ENUMERATE Study

• DOI: 10.1007/s10620-018-5281-3
• Publication Date: 2018-09-20T11:53:25Z
• Authors: Hannah M. Lee; Joseph Ahn; W. Ray Kim; Joseph K. Lim; Mindie Nguyen; Calvin Q. Pan; Donghee Kim; Ajitha Mannalithara; Helen Te; Huy Trinh; Danny Chu; Tram Tran; Jocelyn Woog; Anna S. Lok
• Keywords: Adult; Liver Cirrhosis; Male; Academic Medical Centers; Guanine; Hepatitis B Surface Antigens; Asian; Liver Neoplasms; Alanine Transaminase; Middle Aged; Antiviral Agents; 3. Good health; Black or African American; 03 medical and health sciences; Deprescriptions; Hepatitis B, Chronic; 0302 clinical medicine; DNA, Viral; Humans; Female; Community Health Services; Hepatitis B e Antigens; 10. No inequality; Retrospective Studies

The management of chronic hepatitis B patients is not well characterized in real-world practice. We compared baseline characteristics of CHB patients on entecavir, the frequency of on-treatment monitoring, and the effectiveness of ETV treatment between academic and community practices.Treatment-naïve CHB patients ≥18 years old, treated with ETV for ≥12 months from 2005 to 2013, in 26 community and academic practices throughout the USA were retrospectively evaluated.Of 841 patients enrolled, 658 (65% male, 83% Asian, median age 47, 9% with cirrhosis) met inclusion criteria. Half of the patients (52%) were from community practices. A lower percentage of patients in community practices had cirrhosis or liver cancer (5 vs. 14%). Community practices more often treated patients with baseline ALT < 2 × ULN. Over a median follow-up of 4 years, community practices were more likely to discontinue ETV with less frequent laboratory monitoring compared to academic practices. The 5-year cumulative probability of ALT normalization was greater among patients treated in community practices (70 vs. 50%, p < 0.001), but the 5-year cumulative probability of undetectable HBV DNA was lower (45 vs. 70%, p < 0.001) than those treated in academic practices.Academic practices saw CHB patients with more advanced liver disease, more often followed AASLD guidelines, and monitored patients on ETV treatment more frequently than community practices. While patients in community practices were less likely to achieve undetectable HBV DNA and more likely to achieve ALT normalization, the rates of HBeAg loss and seroconversion as well as HBsAg loss were similar.