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Öğe The Effects of the COVID-19 Pandemic on Clinical and Laboratory Follow-up of Patients Diagnosed With Chronic Hepatitis B: A Multicenter, Prospective, Observational Study(Briefland, 2022) Akgul, Fethiye; Arslan, Yusuf; Celik, Mehmet; Karasahin, Omer; Celen, Mustafa KemalBackground: Chronic hepatitis B (CHB) patients who are under the treatment of antiviral agents should be monitored in routine control visits. However, during the COVID-19 pandemic, the visits were interrupted. Objectives: This study aimed to investigate whether these patients were affected regarding clinical, laboratory, and treatment outcomes. Methods: This prospective study consisted of CHB patients aged > 18 who were applied to 3 tertiary centers between 14 February and 30 March 2022. The patients were selected from the ones who regularly applied to outpatient clinics and under the treatment of antiviral agents before the pandemic. The demographic and laboratory values, including serologic, biochemistry, and molecular results, were compared between the 2 groups who came and did not come to control visits. Results: A total number of 220 patients were included. More than half (n = 142, 64.5%) were female. The median age was 44 years (19 - 73). A hundred and forty-two (64.5%) patients did not come to control visits during the pandemic. The most common reason was anxiety about COVID-19. The tenofovir treatment was replaced with entecavir (ETV) due to osteopenia and with alafenamide due to osteopenia and/or renal failure. The previous agents were re-started in 27 (79.5%) patients who discontinued the treatment. Conclusions: The COVID-19 pandemic negatively impacted the follow-up of CHB patients. In this regard, 15.5% of patients stopped their treatments. The patients who stopped their follow-ups and continued tenofovir disoproxil fumarate (TDF) had proteinuria and decreases in bone mineral density (BMD) and estimated glomerular filtration rate (eGFR) levels.Öğe Evaluation of chronic hepatitis B patients who voluntarily discontinued oral antiviral therapy: is there an answer to the controversial topic?(Lippincott Williams & Wilkins, 2024) Arslan, Eyup; Yildiz, Yesim; Karasahin, Omer; Demir, Yakup; Mermutluoglu, Cigdem Tumbul; Unlu, Gulten; Kuscu, FeritObjectiveThe uncertain treatment duration for nucleos(t)ide analogues (NA) used in the treatment of chronic hepatitis B (CHB) is an important problem for both patients and physicians. The aim of this study was to evaluate the determinants of virologic relapse (VR) and the optimum time of treatment discontinuation in the follow-up of CHB patients who voluntarily discontinued treatment after virological suppression was achieved under NA use.MethodsData from 138 patients from 11 centers were included in this registry-based study. Factors associated with VR were investigated using multivariate Cox regression analysis.ResultsNinety-nine (71.7%) of the patients were HBeAg (Hepatitis B e antigen) negative. During the 24-month follow-up period after treatment discontinuation, VR occurred in 58.7% (n = 81) of all patients and 57.6% (n = 57) of HBeAg-negative patients. The duration of NA treatment was significantly shorter (cutoff 60 months) in HBeAg-negative patients who later developed VR. In addition, the duration of virologic remission achieved under NA treatment was significantly shorter (cutoff 52 months) in those who later developed VR. In the Cox multivariate regression model of HBeAg-negative patients, having less than 60 months of NA treatment (HR = 2.568; CI:1.280-5.148; P = 0.008) and the levels of alanine aminotransferase being equal to or higher than twice the upper level of normal at the beginning of treatment (HR = 3.753; CI:1.551-9.081; P = 0.003) were found to be statistically significant and independently associated with VR.ConclusionThe findings of this study may provide clinical guidance in terms of determining the most appropriate discontinuation time for NA.Öğe Risk factors for relapse after discontinuation of tenofovir or entecavir in hepatitis B e antigen-negative patients(Kare Publ, 2024) Mermutluoglu, Cigdem; Karasahin, Omer; Celen, Mustafa KemalBackground and Aim: This study aimed to define the relapse frequency and risk determinants in chronic hepatitis B (CHB) patients who discontinued nucleoside analog (NA) treatment, were HBeAg-negative, and had achieved both a virological and biochemical response. Materials and Methods: This retrospective cohort study reviewed patients with HBeAg-negative CHB who received antiviral therapy for at least 65 months between January 1, 2013, and December 31, 2020. These patients discontinued treatment after demonstrating a biochemical and virological response and were evaluated at 6, 12, and 24 months post-treatment discontinuation. Results: Sixty-seven patients with CHB who received NA therapy for at least 65 months, discontinued treatment, and had undetectable HBV DNA and normal ALT values were evaluated. After cessation of NA therapy, a relapse was observed in 38 patients (56.7%). The relapse rate was 71.0% in patients treated with tenofovir disoproxil fumarate (TDF) as the last NA type and 37.9% in patients treated with entecavir (ETV) (p=0.017). The cutoff value for the best estimate of age for predicting relapse was 42 years. The relapse rate was 69.2% in patients aged >42 years and 39.2% in patients aged <42 years (p=0.007). The relapse rate was 51.3% in patients with a pre-treatment fibrosis score of 2, 56.0% in those with a fibrosis score of 3, and 100% in those with a fibrosis score of 4 (p=0.089). Conclusion: Among HBeAg-negative CHB patients who achieved a virological and biochemical response to long-term antiviral therapy, those aged 42 years and older, those with high fibrosis scores before treatment, treatment.Öğe Sofosbuvir/Velpatasvir/Voxilaprevir Experience in Treatment-Naive Chronic Hepatitis C Patients: Preliminary Findings of Real World Data(Galenos Publ House, 2023) Cakirca, Tuba Damar; Yamazhan, Tansu; Yuksekkaya, Esra; Akgul, Fethiye; Kurtaran, Behice; Karasahin, Omer; Karabay, OguzObjectives: The aim of this study was to present the preliminary findings of real-world data of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) in treatment-naive chronic hepatitis C (CHC) patients, which was approved for the first time in treatment-naive patients in Turkey. Materials and Methods: This retrospective, cross-sectional, multicenter and national study comprised treatment-naive CHC patients receiving SOF/VEL/VOX between June-December 2022 in ten centers from Turkey. The sustained virological response (SVR) was defined as undetectable hepatitis C virus (HCV)-RNA after at least 12 weeks or more from the end of antiviral therapy. Results: Forty one patients initiating SOF/VEL/VOX were included in the study; median age 55 [interquartile range (IQR): 34.5-61 years], 63.4% males, and median HCV-RNA 521,644 IU/mL. Genotype distribution ranged from 1 to 4 in 28 patients who underwent genotype analysis, and genotype-1 was detected in 24 (85.7%) patients. The most common risk factor was substance abuse (n=10, 24.4%) and the most common comorbidity was hypertension (n=111, 26.8%). 3 (7.3%) patients had compensated cirrhosis and one (2.4%) had hepatocellular carcinoma. While in the 1st month of treatment, HCV-RNA was negative in all patients except one patient, at the end of treatment all patients' viral load was negative. SVR12 results were available in 23 patients and SVR24 in 10 patients. SVR12 and SVR24 were achieved in all patients who could be evaluated (100%) (SVR12, 23/23; SVR24, 10/10). Adverse events were reported by two patients: Diarrhea (2.4%) and nausea (2.4%), but did not lead to a discontinuation of treatment. Conclusion: The preliminary results of our study corroborated the efficacy and well tolerateability of SOF/VEL/VOX in treatment- naive CHC patients. High SVR rates were also observed across genotypes 1, 2, 3, 4 with the pangenotypic SOF/VEL/VOX.
