Journal of Gastroenterology

, Volume 54, Issue 2, pp 182–193 | Cite as

Long-term outcome of entecavir treatment of nucleos(t)ide analogue-naïve chronic hepatitis B patients in Japan

  • Fumitaka SuzukiEmail author
  • Tetsuya Hosaka
  • Yoshiyuki Suzuki
  • Hitomi Sezaki
  • Norio Akuta
  • Shunichiro Fujiyama
  • Yusuke Kawamura
  • Masahiro Kobayashi
  • Satoshi Saitoh
  • Yasuji Arase
  • Kenji Ikeda
  • Mariko Kobayashi
  • Rie Mineta
  • Yukiko Suzuki
  • Hiromitsu Kumada
Original Article—Liver, Pancreas, and Biliary Tract



We determined the antiviral potency and viral breakthrough rate after 10 years of continuous entecavir treatment in patients with chronic hepatitis B (CHB) infection.


The cumulative rates of undetectable hepatitis B virus DNA (HBV-DNA, < 2.1 log copies/mL), alanine aminotransferase (ALT) normalization, hepatitis B e antigen (HBeAg) seroclearance, hepatitis B surface antigen (HBsAg) seroclearance, and viral breakthrough of 1094 nucleos(t)ide analogue-naïve CHB patients (HBeAg-positive: 47%) who were on continuous entecavir treatment for 10 years were calculated.


The median age was 50 years and follow-up period was 5.5 years, with 999, 804, 591, 390, 182 and 87 patients followed up for at least 1, 3, 5, 7, 9 and 10 years, respectively. Incremental increases were noted in the rates of undetectable HBV-DNA, ALT normalization, HBeAg seroclearance, and HBsAg seroclearance, reaching 96, 79, 38 and 3.7%, respectively, by the tenth year. The mean decline in HBsAg level from baseline was − 0.08 log IU/mL/year. Multivariate analysis identified HBsAg level and genotype (A) as independent predictors of HBsAg seroclearance. Sixteen patients experienced viral breakthrough. The cumulative percentages of patients with viral breakthrough analyzed by the Kaplan–Meier test were 1.5 and 2.5% at years 5 and 10, respectively. There were no serious adverse events during treatment.


Long-term entecavir treatment of nucleos(t)ide analogue-naïve CHB patients was associated with an excellent viral response and a low rate of entecavir-resistant mutations at 10 years. Baseline HBsAg levels and genotype were predictors of HBsAg seroclearance during entecavir treatment.


Hepatitis B virus Entecavir HBsAg seroclearance Resistance Viral breakthrough 



Chronic hepatitis B


Nucleos(t)ide analogue


Tenofovir disoproxil fumarate


Hepatitis B virus


Hepatitis B e antigen


Alanine aminotransferase


Hepatitis B surface antigen


Polymerase chain reaction


Reverse transcriptase




Hazard ratio


Confidence interval


Aspartate transaminase




Receiver operating characteristic


Hepatocellular carcinoma


Nonalcoholic fatty liver disease



This study was supported in part by Okinaka Memorial Institute for Medical Research, and by grants from the Ministry of Health, Labor and Welfare of Japan and Japan Agency for Medical Research and Development.

Compliance with ethical standards

Conflict of interest

Dr. Suzuki F received lecture fees from Bristol-Myers Squibb, Gilead Sciences Inc. and Abbvie. Dr. Suzuki Y received lecture fees from Bristol-Myers Squibb. Dr. Akuta received lecture fees from Abbvie. Dr. Ikeda received lecture fees from Sumitomo Dainippon Pharma Co. Ltd, Olympus, Esai Co. Ldt, Otsuka Pharmaceuical, Nippon Kayaku Co. Ldt, and Bayer. Dr. Kumada received investigator, lecture and consulting fees from Bristol-Myers Squibb, Gilead Sciences Inc. Abbvie, MSD, and Sumitomo Dainippon Pharma Co. Ltd. The other authors declare that they have no conflict of interest.

Supplementary material

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Fumitaka Suzuki
    • 1
    • 2
    Email author
  • Tetsuya Hosaka
    • 1
  • Yoshiyuki Suzuki
    • 1
  • Hitomi Sezaki
    • 1
  • Norio Akuta
    • 1
  • Shunichiro Fujiyama
    • 1
  • Yusuke Kawamura
    • 1
  • Masahiro Kobayashi
    • 1
  • Satoshi Saitoh
    • 1
  • Yasuji Arase
    • 1
  • Kenji Ikeda
    • 1
  • Mariko Kobayashi
    • 3
  • Rie Mineta
    • 3
  • Yukiko Suzuki
    • 3
  • Hiromitsu Kumada
    • 1
  1. 1.Department of HepatologyToranomon HospitalTokyoJapan
  2. 2.Okinaka Memorial Institute for Medical ResearchTokyoJapan
  3. 3.Research Institute for HepatologyToranomon Branch HospitalKawasakiJapan

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