studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 985A
able on post-delivery flares in patients treated with tenofovir
(TDF) during pregnancy. Aim: Cross-sectional observational,
single centre study to compare the frequency of post-delivery
flares in untreated CHB mothers and in CHB patients
requiring therapy during pregnancy (due to liver disease or
prevent HBV transmission) and evaluate the importance virological
(HBV DNA), serological (HBeAg and HBsAg levels)
and immunological markers (IP10 levels) during pregnancy
(2 nd trimester) on predicting post-delivery flares. Patients: 297
CHB patients (median age 31.1years, 16% HBeAg+) were
assessed at 2 nd pregnancy trimester (1 st visit median gestation
week 26); 35 patients were treated with TDF prior to pregnancy,
39 patients started TDF from gestation week 28 to prevent
HBV transmission and 223 untreated patients (all HBV
DNA38IU/l and increase by two-fold pregnancy level. 36
patients stopped therapy shortly after delivery. Results: Treated
patients had higher frequency of flares than untreated mothers
(51% vs. 26%,p200pg/ml) (OR
4.6, 1.8-11.4), HBV DNA (>10000IU/ml) (OR 9.2, 4.9-16.9),
HBsAg (>20000IU/ml) (OR 5.5, 2.5-12.2) and higher HBeAg
(>1000S/CO) levels (OR 5.7, 0.5-60) at 2 nd pregnancy trimester.
While only high IP10 was predictive of HF in untreated
mothers (OR 4.2, 1.5-10.2); higher HBV DNA, HBsAg, HBeAg
and IP10 levels and younger age ( Methods: Based on Taiwan National Health Insurance
Research Database, 176,120 patients diagnosed with RA or
psoriasis were screened for eligibility. Only those having past
HBV infection were screened. After excluding those having
other hepatitis, taking antiviral drugs for viral hepatitis or those
with malignant diseases, we enrolled a total of 354 eligible
patients who received TNF-α antagonists (biologics cohort)
and matched them 1: 2 with 708 patients who received nbD-
MARDs alone by baseline characteristics and propensity scores
(DMARDs cohort). Both cohorts were followed up for the occurrence
of HBV hepatitis flare after starting TNF-α antagonists.
Results: The 5-year cumulative incidences of HBV hepatitis flare
were 19.3% (95% confidence interval [CI] 13.8-24.9%) and
12.9% (95% CI 9.2-16.6%) for the Biologics and DMARDs
cohorts, respectively (P=0.004). On modified Cox proportional
hazards analysis, patients in the biologics cohort had
significantly higher risk of HBV hepatitis flare (adjusted HR
2.10, 95% CI 1.3-3.3, P Conclusion:
Biologics use is associated with significantly higher risk of
HBV hepatitis flare than DMARDs in RA or psoriasis patients.
Disclosures:
The following authors have nothing to disclose: Chun-Ying Wu, Yi-Ju Chen, Jaw-
Town Lin
1590
The PAGE-B Score Accurately Predicts Clinical Outcome
and Outperforms Other Biomarkers over 15 Years of
Follow-up in a Diverse Cohort of Chronic Hepatitis B
Patients
Willem Pieter Brouwer 1 , Adriaan J. van der Meer 1 , Andre Boonstra
1 , Elisabeth P. Plompen 1 , Suzan D. Pas 1 , Robert J. de Knegt 1 ,
Robert A. de Man 1 , Fiebo J. ten Kate 1 , Harry L. Janssen 2,1 , Bettina
E. Hansen 1 ; 1 Gastroenterology & Hepatology, Erasmus Medical
Center Rotterdam, Rotterdam, Netherlands; 2 Gastroenterology and
Hepatology, UHN Liver Clinic, Toronto, ON, Canada
Background & aims. Multiple non-invasive markers have been
associated with hepatocellular carcinoma (HCC) development
in chronic hepatitis B (CHB) patients. We aimed to compare the
prognostic performance of these markers and to assess whether
liver histology could improve this performance. Methods. Liver
biopsies from consecutive treatment-naïve CHB patients were
scored by a single experienced hepato-pathologist. Laboratory
values at the time of biopsy were used to calculate the PAGE-B,
REACH-B, GAG-HCC, and CU-HCC scores. A clinical event
was defined as a combined endpoint including HCC development,
liver failure, liver transplantation, and all-cause mortality.
Event data was obtained from national database registries.
Results. Of 557 patients, mean age at biopsy was 35±13
years, 47/31/19% was Caucasian/Asian/African, 63%
received antiviral therapy (AVT) after liver biopsy and 113
(20%) had advanced fibrosis (F3/F4). Forty patients developed
a clinical event within a median follow-up of 10.1 years
(IQR 5.7-15.9, complete follow-up 93%). The PAGE-B score
predicted any clinical outcome (C-statistic [C] 0.87, 95%CI:
0.81-0.92), HCC development (C: 0.89) and reduced transplant-free
survival (C: 0.84) with good accuracy, also when
stratified by ethnicity, AVT after biopsy or advanced fibrosis.
The REACH-B, GAG-HCC, and CU-HCC predicted clinical outcome
less accurate (C: 0.70, 0.82, and 0.73, respectively).