• G Vourli, G Papatheodoridis, M Raptopoulou, G N Dalekos, A Hounta, G Nikolopoulou, I Zouboulis-Vafeiadis, E Manesis, G Kitis, C Gogos, I Ketikoglou, G Hatzis, T Vasilialdis, S Karatapanis, K Mimidis, C Drakoulis, G Touloumi, and The Hepnet-Greece Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece..
• Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
• Hippokratia. 2016 Jul 1; 20 (3): 214-221.

Background And AimsAlthough effective treatment in terms of inducing virological and biochemical response for chronic hepatitis B (CHB) is available, its effect on the clinical course of the disease has not yet been accurately estimated. Objective of this study was to evaluate the effect of antiviral therapy and its type [interferon +/- nucleos(t)ide analogs (NAs) vs. NAs] on the occurrence of a clinical event (liver decompensation, liver transplant, hepatocellular carcinoma and death from a liver-related cause) in CHB patients.MethodsThe study population was derived from the HEPNET-Greece, a nationwide cohort study aimed to evaluate the current epidemiological course of viral hepatitis. To account for time-dependent confounding, Cox marginal structural models were used to analyze data.ResultsThirty out of 2,125 eligible patients experienced a clinical event during their follow-up. When comparing treated to untreated individuals, the hazard ratio (HR) for a clinical event was 0.39 (95% CI: 0.16-0.98; p =0.044) in the whole sample, whereas there were indications of a more intense effect in the subgroup of patients with cirrhosis at presentation (HR =0.16, 95% CI: 0.02-1.21; p =0.075). The effect of Interferon initiated treatment was not significantly different of that of NAs. There was some evidence, albeit not statistically significant, of a protective treatment effect on hepatocellular carcinoma development (HCC).ConclusionsData from observational studies can provide useful inference, provided they are analyzed appropriately. The current study has shown that the available treatment options for CHB offer a significant clinical benefit to CHB infected individuals. Hippokratia 2016, 20(3): 214-221.

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