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Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe SOGNI
Coup de coeur :
 
 
Hepatology
  2015/09  
 
  2015 Sep;62(3):684-93  
  doi: 10.1002/hep.27894  
 
  Long-term safety of oral nucleos(t)ide analogs for patients with chronic hepatitis B: A cohort study of 53,500 subjects  
 
  Wong GL, Tse YK, Wong VW, Yip TC, Tsoi KK, Chan HL  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Long-term+safety+of+oral+nucleos%28t%29ide+analogs+for+patients+with+chronic+hepatitis+B%3A+A+cohort+study+of+53%2C500+subjects  
 
 

Abstract
Widespread and long-term use of oral nucleos(t)ide analogs (NAs) to treat chronic hepatitis B (CHB) brings about safety data in a real-life setting. We aimed to determine the risks of renal and bone side effects in patients receiving or who have received NAs as CHB treatment. A territory-wide cohort study using the database from Hospital Authority, the major provider of medical services in Hong Kong, was conducted. We identified CHB patients by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, diagnosed between 2000 and 2012. The primary events were renal (incident renal failure and renal replacement therapy [RRT]) and bone events (incident hip, vertebral, and all fractures). A 3-year landmark analysis was used to evaluate the relative risk of primary outcome in patients with or without NA treatment. A total of 53,500 CHB patients (46,454 untreated and 7,046 treated), who were event free for 3 years, were included in the analysis. At a median follow-up of 4.9 years, chronic renal failure, RRT, all fractures, hip fractures, and vertebral fractures occurred in 0.6%, 0.2%, 0.7%, 0.1%, and 0.1% of untreated subjects and 1.4%, 0.7%, 1.3%, 0.2%, and 0.2% of treated subjects. After propensity score weighting, NA therapy did not increase the risk of any of the events (hazard ratios [HRs] ranged from 0.79 to 1.31; P = 0.225-0.887). Exposure to nucleotide analogues, compared with nucleoside analogs, increased the risk of hip fracture (HR = 5.69; 95% confidence interval: 1.98-16.39; P = 0.001), but not other events (HR = 0.58-1.44; P = 0.202-0.823).

Conclusions
NA treatment does not increase the risk of renal and bone events in general. Nucleotide analogs may increase the risk of hip fracture, but the overall event rate is low. (Hepatology 2015;62:684-693)

 
Question posée
 
Quel est le risque rénal et osseux des analogues nucléos(t)idiques dans le traitement de l’hépatite B dans une grosse cohorte chinoise (Hong-Kong) suivie pendant pratiquement 5 ans ?
 
Question posée
 
Aucun signal observé sur le risque de survenue d’une insuffisance rénale terminale ou le risque fracturaire sous traitement par analogue entre patients traités et non traités. Peut-être une augmentation du risque de fracture de hanche sous analogue nucléotidique par rapport à un analogue nucléosidique.
 
Commentaires

Cette étude est intéressante par le nombre de patients suivis et la comparaison entre patients traités et non traités. Cependant, on peut s’interroger sur la sensibilité des évènements d’intérêt : survenue d’une insuffisance rénale terminale (moins sensible que la diminution de la clearance de la créatinine), survenue d’une fracture (moins sensible qu’une baisse de la minéralisation osseuse).

 
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