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Normal alanine aminotransferase protects against hepatic events in CHB patients

24 Sep 2018

In patients with chronic hepatitis B (CHB) infections on nucleos(t)ide analogue (NA) treatment, normal on-treatment alanine aminotransferase (ALT) levels are associated with lower risks of hepatic events, a recent study has shown.

Using data from the Clinical Data Analysis and Reporting System of Hong Kong, researchers evaluated serial on-treatment ALT levels of 21,182 CHB patients (mean age 51±13 years). ALT <30 and <19 U/L in males and females, respectively, were considered as normal. Composite hepatic events, including hepatocellular carcinoma, were the study outcomes.

Of the participants, 10,438 achieved normal on-treatment ALT levels within 12 months of NA treatment, while 10,745 did not. Only a minority (3.0 percent; n=627) of the patients developed the primary study outcome of composite hepatic events over a mean follow-up period of 4.0±1.7 years. Most of these were hepatocellular carcinoma (2.4 percent; n=509).

The cumulative hepatic event rates were lower in those with normal vs elevated on-treatment ALT at different time points: 3 months (4.27 percent vs 4.76 percent; p=0.083), 6 months (3.60 percent vs 5.24 percent; p<0.001), 9 months (3.44 percent vs 5.57 percent; p<0.001) and 12 months (3.51 percent vs 5.70 percent; p<0.001).

These were confirmed in fully adjusted Cox regression analyses, which showed that the risk of composite hepatic events were significantly lower in those with normal vs elevated ALT at 3 months (adjusted hazard ratio [HR], 0.61; 95 percent CI, 0.49–0.77; p<0.001), 6 months (adjusted HR, 0.55; 0.45–0.67; p<0.001), 9 months (adjusted HR, 0.54; 0.44–0.65; p<0.001) and 12 months (adjusted HR, 0.51; 0.42–0.61; p<0.001).

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