▲Professor Young-Suk Lim of the Division of Gastroenterology at Asan Medical Center is treating a patient with chronic hepatitis B.

Early treatment is critical for chronic hepatitis B, a leading cause of liver cancer. However, current guidelines recommend initiating antiviral treatment only when liver enzyme levels are elevated or liver cirrhosis has progressed. Professor Young-Suk Lim of the Division of Gastroenterology at Asan Medical Center and his team recently released a study suggesting that prompt treatment initiation based on the level of hepatitis B virus in the blood, regardless of whether the patient has elevated liver enzyme levels or liver cirrhosis, can lower the risks of liver cancer and mortality.

The research team conducted a randomized clinical trial involving 734 chronic hepatitis B patients from 22 hospitals in South Korea and Taiwan. While participants did not have liver cirrhosis, and their liver enzyme levels were within the normal range, they had moderate to high levels of hepatitis B virus concentration in the blood. The patients were randomized into a treatment group (369 patients) receiving antivirals or an observation group (365 patients) without treatment. The treatment group was administered a daily dose of antiviral medication, tenofovir alafenamide (TAF). After an average follow-up of 17 months, the incidence of liver cancer, hepatic failure, liver transplantation, or death was 0.33 cases per 100 people in the treatment group, compared to 1.57 cases in the observation group, indicating a 79% risk reduction in the treatment group. The incidence of other serious adverse events was similar between both groups, at 6% in the treatment group and 7% in the observation group.

Professor Young-Suk Lim said, “Approximately 70% of liver cancer cases in South Korea are caused by chronic hepatitis B, but only 20% of those patients are prescribed antiviral drugs due to the strict treatment standards today. We need to revise clinical guidelines and health insurance coverage criteria based on the study findings. Applying viral treatment at an early stage is expected to prevent about 43,000 cases of liver cancer and 37,000 premature deaths in South Korea over the next 15 years.”

The study findings were recently published in the international academic journal ‘The Lancet Gastroenterology & Hepatology’.