15 research outputs found
Prevalence and predictors of complementary and alternative medicine modalities in patients with chronic hepatitis B
Background & Aims
The use of complementary and alternative medicine (CAM) in patients with chronic hepatitis B (CHB) can interact with antiviral treatment or influence healthâseeking behaviour. We aimed to study the use of individual CAM modalities in CHB and explore determinants of use, particularly migrationârelated, socioâeconomic and clinical factors.
Methods
A total of 436 CHB outpatients who attended the Toronto Centre for Liver Disease in 2015â2016 were included in this crossâsectional study. Using the comprehensive IâCAM questionnaire and health records, data were collected on socioâdemographic and clinical variables and on usage of 16 CAM modalities in the last year.
Results
Sixty percent of patients were male, 74% were Asian and 46% were using antiviral treatment. Threeâhundred and nine (71%) patients used CAM. Vitamin/mineral preparations (45% of patients) were most commonly used. Overall CAM use and the specific use of potentially injurious CAM, such as green tea extract (9.2%) and St. John's wort (0.2%), were not associated with liver disease severity. Female sex, family history of CHB, lower serum HBV DNA, and higher socioâeconomic status were independently associated with bioâholistic CAM use, the clinically mostârelevant CAM group (P < 0.05); ethnicity, antiviral therapy use and liver disease severity were not.
Conclusions
CAM use among CHB patients was extensive, especially use of vitamin and mineral preparations, but without direct influence on liver disease severity. Bioâholistic CAM use appeared to be associated with socioâeconomic status rather than with ethnicity or liver disease severity. Despite the rare use of hepatotoxins, physicians should actively inquire about it
Low hepatitis B surface antigen and HBV DNA levels predict response to the addition of pegylated interferon to entecavir in hepatitis B e antigen positive chronic hepatitis B
Background: Various treatment combinations of peginterferon (PEGâIFN) and
nucleos(t)ide analogues have been evaluated for chronic hepatitis B (CHB), but the
optimal regimen remains unclear.
Aims: To study whether PEGâIFN addâon increases response compared to entecavir
(ETV) monotherapy, and whether the duration of ETV pretreatment influences
response.
Methods: Response was evaluated in HBeAg positive patients previously treated in
two randomized controlled trials. Patients received ETV pretreatment for at least
24 weeks and were then allocated to 24â48 weeks of ETV+PEGâIFN addâon, or
continued ETV monotherapy. Response was defined as HBeAg loss combined with
HBV DNA <200 IU/mL 48 weeks after discontinuing PEGâIFN.
Results: Of 234 patients, 118 were assigned PEGâIFN addâon and 116 continued
ETV monotherapy. Response was observed in 38/118 (33%) patients treated with
addâon therapy and in 23/116 (20%) with monotherapy (P = 0.03). The highest
response to addâon therapy compared to monotherapy was observed in PEGâIFN
naive patients with HBsAg levels below 4000 IU/mL and HBV DNA levels below
50 IU/mL at randomization (70% vs 34%; P = 0.01). Above the cutâoff levels,
response was low and not significantly different between treatment groups. Duration of ETV pretreatment was associated with HBsAg and HBV DNA levels (both
P < 0.005), but not with response (P = 0.82).
Conclusions: PEGâIFN addâon to ETV therapy was associated with higher response
compared to ETV monotherapy in patients with HBeAg positive CHB. Response
doubled in PEGâIFN naive patients with HBsAg below 4000 IU/mL and HBV DNA
below 50 IU/mL, and therefore identifies them as the best candidates for PEGâIFN
addâon (Identifiers: NCT00877760, NCT01532843)