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. 2023 Jan;53(1):35-42.
doi: 10.1111/hepr.13839. Epub 2022 Oct 4.

Alanine aminotransferase levels as therapeutic targets after nucleotide/nucleoside analog therapy in patient with chronic hepatitis B

Sakura Kirino  1   2 , Nobuharu Tamaki  1 , Masayuki Kurosaki  1 , Shun Kaneko  1   2 , Kento Inada  1   2 , Yuki Tanaka  1 , Shun Ishido  1   2 , Koji Yamashita  1 , Tsubasa Nobusawa  1   2 , Hiroaki Matsumoto  1   2 , Yuka Hayakawa  1   2 , Tatsuya Kakegawa  1 , Mayu Higuchi  1 , Kenta Takaura  1 , Shohei Tanaka  1   2 , Chiaki Maeyashiki  1   2 , Yutaka Yasui  1 , Yuka Takahashi  1 , Kaoru Tsuchiya  1 , Hiroyuki Nakanishi  1 , Ryuichi Okamoto  2 , Namiki Izumi  1
Affiliations

Alanine aminotransferase levels as therapeutic targets after nucleotide/nucleoside analog therapy in patient with chronic hepatitis B

Sakura Kirino et al. Hepatol Res. 2023 Jan.

Abstract

Aim: Alanine aminotransferase (ALT) is a criterion for the introduction of nucleotide/nucleoside analog (NA), and ALT levels are decreased by NA treatment. However, the association between post-treatment ALT levels and hepatocellular carcinoma (HCC) risk remains unclear. To fill this gap, we aimed to establish a target value of ALT level during NA treatment.

Methods: In total, 413 patients with chronic hepatitis B who received entecavir, tenofovir alafenamide, or tenofovir disoproxil fumarate were enrolled. The subsequent development of HCC was examined and a target value of ALT level during NA treatment as a risk marker for HCC was evaluated.

Results: The median follow-up duration was 5.1 years, during which time 27 patients (8.6%) developed HCC. ALT level at the start of treatment was not associated with HCC development (p = 0.08). When stratified by ALT at 1 year after NA initiation, the cumulative 3- and 5-year rates of HCC for patients with ALT ≥21 IU/L were 11.5% and 18.1%, and those with ALT <21 IU/L was 2.3% and 6.5%, respectively. Patients with ALT <21 IU/L had a significantly lower risk of HCC development compared with patients with ALT ≥21 IU/L (p = 0.002). In multivariable analysis adjusting age, sex, and platelet counts, ALT ≥21 IU/L was an independent risk factor of HCC development with hazard ratio of 4.5 (95% confidence interval: 1.01-20.4).

Conclusions: ALT <21 IU/L at 1 year after NA initiation has a lower risk of HCC and could be used as a target value for NA treatment.

Keywords: alanine aminotransferase; hepatitis B virus; hepatocellular carcinoma; nucleoside/nucleotide analog.

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References

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